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Predictive parameters and model for extubation outcome in pediatric patients

BACKGROUND: Prolonged mechanical ventilation is associated with significant morbidity in critically ill pediatric patients. In addition, extubation failure and deteriorating respiratory status after extubation contribute to increased morbidity. Well-prepared weaning procedures and accurate identific...

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Autores principales: Charernjiratragul, Kan, Saelim, Kantara, Ruangnapa, Kanokpan, Sirianansopa, Kantisa, Prasertsan, Pharsai, Anuntaseree, Wanaporn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10106763/
https://www.ncbi.nlm.nih.gov/pubmed/37077338
http://dx.doi.org/10.3389/fped.2023.1151068
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author Charernjiratragul, Kan
Saelim, Kantara
Ruangnapa, Kanokpan
Sirianansopa, Kantisa
Prasertsan, Pharsai
Anuntaseree, Wanaporn
author_facet Charernjiratragul, Kan
Saelim, Kantara
Ruangnapa, Kanokpan
Sirianansopa, Kantisa
Prasertsan, Pharsai
Anuntaseree, Wanaporn
author_sort Charernjiratragul, Kan
collection PubMed
description BACKGROUND: Prolonged mechanical ventilation is associated with significant morbidity in critically ill pediatric patients. In addition, extubation failure and deteriorating respiratory status after extubation contribute to increased morbidity. Well-prepared weaning procedures and accurate identification of at-risk patients using multimodal ventilator parameters are warranted to improve patient outcomes. This study aimed to identify and assess the diagnostic accuracy of single parameters and to develop a model that can help predict extubation outcomes. MATERIALS AND METHODS: This prospective observational study was conducted at a university hospital between January 2021 and April 2022. Patients aged 1 month to 15 years who were intubated for more than 12 h and deemed clinically ready for extubation were enrolled. A weaning process with a spontaneous breathing trial (SBT), with or without minimal setting, was employed. The ventilator and patient parameters during the weaning period at 0, 30, and 120 min and right before extubation were recorded and analyzed. RESULTS: A total of 188 eligible patients were extubated during the study. Of them, 45 (23.9%) patients required respiratory support escalation within 48 h. Of 45, 13 (6.9%) were reintubated. The predictors of respiratory support escalation consisted of a nonminimal-setting SBT [odds ratio (OR) 2.2 (1.1, 4.6), P = 0.03], >3 ventilator days [OR 2.4 (1.2, 4.9), P = 0.02], occlusion pressure (P0.1) at 30 min ≥0.9 cmH(2)O [OR 2.3 (1.1, 4.9), P = 0.03], and exhaled tidal volume per kg at 120 min ≤8 ml/kg [OR 2.2 (1.1, 4.6), P = 0.03]; all of these predictors had an area under the curve (AUC) of 0.72. A predictive scoring system to determine the probability of respiratory support escalation was developed using a nomogram. CONCLUSION: The proposed predictive model, which integrated both patient and ventilator parameters, showed a modest performance level (AUC 0.72); however, it could facilitate the process of patient care.
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spelling pubmed-101067632023-04-18 Predictive parameters and model for extubation outcome in pediatric patients Charernjiratragul, Kan Saelim, Kantara Ruangnapa, Kanokpan Sirianansopa, Kantisa Prasertsan, Pharsai Anuntaseree, Wanaporn Front Pediatr Pediatrics BACKGROUND: Prolonged mechanical ventilation is associated with significant morbidity in critically ill pediatric patients. In addition, extubation failure and deteriorating respiratory status after extubation contribute to increased morbidity. Well-prepared weaning procedures and accurate identification of at-risk patients using multimodal ventilator parameters are warranted to improve patient outcomes. This study aimed to identify and assess the diagnostic accuracy of single parameters and to develop a model that can help predict extubation outcomes. MATERIALS AND METHODS: This prospective observational study was conducted at a university hospital between January 2021 and April 2022. Patients aged 1 month to 15 years who were intubated for more than 12 h and deemed clinically ready for extubation were enrolled. A weaning process with a spontaneous breathing trial (SBT), with or without minimal setting, was employed. The ventilator and patient parameters during the weaning period at 0, 30, and 120 min and right before extubation were recorded and analyzed. RESULTS: A total of 188 eligible patients were extubated during the study. Of them, 45 (23.9%) patients required respiratory support escalation within 48 h. Of 45, 13 (6.9%) were reintubated. The predictors of respiratory support escalation consisted of a nonminimal-setting SBT [odds ratio (OR) 2.2 (1.1, 4.6), P = 0.03], >3 ventilator days [OR 2.4 (1.2, 4.9), P = 0.02], occlusion pressure (P0.1) at 30 min ≥0.9 cmH(2)O [OR 2.3 (1.1, 4.9), P = 0.03], and exhaled tidal volume per kg at 120 min ≤8 ml/kg [OR 2.2 (1.1, 4.6), P = 0.03]; all of these predictors had an area under the curve (AUC) of 0.72. A predictive scoring system to determine the probability of respiratory support escalation was developed using a nomogram. CONCLUSION: The proposed predictive model, which integrated both patient and ventilator parameters, showed a modest performance level (AUC 0.72); however, it could facilitate the process of patient care. Frontiers Media S.A. 2023-04-03 /pmc/articles/PMC10106763/ /pubmed/37077338 http://dx.doi.org/10.3389/fped.2023.1151068 Text en © 2023 Charernjiratragul, Saelim, Ruangnapa, Sirianansopa, Prasertsan and Anuntaseree. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Charernjiratragul, Kan
Saelim, Kantara
Ruangnapa, Kanokpan
Sirianansopa, Kantisa
Prasertsan, Pharsai
Anuntaseree, Wanaporn
Predictive parameters and model for extubation outcome in pediatric patients
title Predictive parameters and model for extubation outcome in pediatric patients
title_full Predictive parameters and model for extubation outcome in pediatric patients
title_fullStr Predictive parameters and model for extubation outcome in pediatric patients
title_full_unstemmed Predictive parameters and model for extubation outcome in pediatric patients
title_short Predictive parameters and model for extubation outcome in pediatric patients
title_sort predictive parameters and model for extubation outcome in pediatric patients
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10106763/
https://www.ncbi.nlm.nih.gov/pubmed/37077338
http://dx.doi.org/10.3389/fped.2023.1151068
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