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. 2024 Mar 27;69(4):407-414.
doi: 10.4187/respcare.11312.

Factors Associated With Successful Extubation Readiness Testing in Children With Congenital Heart Disease

Andrew G Miller  1   2 , Jessica Brown  2 , Olivia Marshburn  2 , Dirk Mattin  2 , Jeanette Muddiman  2 , Karan R Kumar  3   4 , Veerajalandhar Allareddy  3 , Alexandre T Rotta  3
Affiliations

Factors Associated With Successful Extubation Readiness Testing in Children With Congenital Heart Disease

Andrew G Miller et al. Respir Care. .

Abstract

Background: In children with congenital heart disease, extubation readiness testing (ERT) is performed to evaluate the potential for liberation from mechanical ventilation. There is a paucity of data that suggests what mechanical ventilation parameters are associated with successful ERT. We hypothesized that ERT success would be associated with certain mechanical ventilator parameters.

Methods: Data on daily ERT assessments were recorded as part of a quality improvement project. In accordance with our respiratory therapist-driven ventilator protocol, patients were assessed daily for ERT eligibility and tested daily, if eligible. Mechanical ventilation parameters were categorized a priori to evaluate the differences in levels of respiratory support. The primary outcome was ERT success.

Results: A total of 780 ERTs from 320 subjects (median [interquartile range] age 2.5 [0.6-6.5] months and median weight [interquartile range] 4.2 [3.3-6.9] kg) were evaluated. A total of 528 ERTs (68%) were passed, 306 successful ERTs (58%) resulted in extubation, and 30 subjects (9.4%) were re-intubated. There were statistically significant differences in the ERT pass rate for ventilator mode, peak inspiratory pressure, Δ pressure, PEEP, mean airway pressure ([Formula: see text]), and dead-space-to-tidal-volume ratio (all P < .001) but not for [Formula: see text]. ERT success decreased with increases in peak inspiratory pressure, Δ pressure, PEEP, [Formula: see text], and dead-space-to-tidal-volume ratio. Logistic regression revealed neonates, Δ pressure ≥ 11 cm H2O, and [Formula: see text] > 10 cm H2O were associated with a decreased odds of ERT success, whereas children ages 1-5 years and an [Formula: see text] of 0.31-0.40 had increased odds of ERT success.

Conclusions: ERT pass rates decreased as ventilator support increased; however, some subjects were able to pass ERT despite high ventilator support. We found that [Formula: see text] was associated with ERT success and that protocols should consider using [Formula: see text] instead of PEEP thresholds for ERT eligibility. Cyanotic lesions were not associated with ERT success, which suggests that patients with cyanotic heart disease can be included in ERT protocols.

Keywords: ERT; children; congenital heart disease; extubation; pediatrics; spontaneous breathing trial; ventilator weaning.

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Conflict of interest statement

Mr Miller is a section editor for Respiratory Care and discloses relationships with Saxe Communications, S2N Health, and Fisher & Paykel. Dr Rotta discloses relationships with Vapotherm, Breas US, and Elsevier. The other authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Extubation readiness testing (ERT) success rates based on a priori categories of ventilatory parameters. PIP = peak inspiratory pressure; Δ pressure = inspiratory pressure or pressure support; VD/VT = dead space to tidal volume ratio.
See this image and copyright information in PMC

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References

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