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Am. J. Respir. Crit. Care Med., Volume 160, Number 5, November 1999, 1562-1566

Predictors of Successful Extubation in Children

RAVI R. THIAGARAJAN, SUSAN L. BRATTON, LYNN D. MARTIN, THOMAS V. BROGAN, and DEBRA TAYLOR

Department of Anesthesiology and Pediatrics, University of Washington School of Medicine, Division of Pediatric Anesthesiology and Critical Care, Children's Hospital and Regional Medical Center; and Respiratory Care Services, Children's Hospital and Regional Medical Center, Seattle, Washington

Objective criteria to predict extubation outcome in mechanically ventilated children are not available. Our goal was to study factors associated with extubation success and to evaluate the usefulness of the rapid shallow breathing index (RSBI) and the compliance, resistance, oxygenation, and pressure index (CROP index) in children. Data were prospectively collected on 227 mechanically ventilated children. Patients successfully extubated had significantly better lung compliance (Cdyn: 0.59 ± 0.91 versus 0.39 ± 0.14 ml/kg/cm H2O), higher PaO2/FIO2 ratio (382.4 ± 181.2 versus 279.8 ± 93.9), and lower PaCO2 (41.3 ± 6.7 versus 47.3 ± 8.5 mm Hg). Spontaneous breathing parameters showed significantly lower respiratory rates (RR) (36.6 ± 17.9 versus 52.8 ± 23 breaths/min), larger tidal volumes (VT) (7.3 ± 2.6 versus 4.9 ± 1.8 ml/kg), and greater muscle strength (negative inspiratory force [NIF]: 41.8 ± 15.4 versus 35.1 ± 12.5 cm H2O) in successfully extubated children. Extubation failures had higher RSBIs and lower CROP index values. A RSBI value of =< 8 breaths/ml/kg had a sensitivity of 74% and specificity of 74%, whereas a CROP value of >=  0.15 ml/kg/breaths/min had a sensitivity of 83% and specificity of 53% for extubation success. Children failing extubation demonstrate abnormalities of respiratory function. The RSBI and CROP index are useful to predict pediatric extubation success. Thiagarajan RR, Bratton SL, Martin LD, Brogan TV, Taylor D. Predictors of successful extubation in children.




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Copyright © 1999 American Thoracic Society