2004 OPEN FORUM Abstracts
INITIAL EXPERIENCE WITH AN RT-DRIVEN EXTUBATION READINESS TEST FOR MECHANICALLY VENTILATED CHILDREN
Daphne
Munhall RRT, Peter Betit RRT, John Thompson RRT, Adrian Randolph
MD Children’s Hospital and Harvard Medical School, Boston, MA
Background:
Protocols have not been shown to significantly expedite the weaning
process for mechanically ventilated children, but periodic
evaluations of extubation readiness may shorten ventilator duration1.
We report our initial experience with an RT-driven extubation
readiness test (ERT) in an 18 bed PICU.
Methods: The ERT was
conducted in patients with a stable and adequate respiratory drive.
Eligible patients were changed to pressure support ventilation at a
minimal level (based on ETT size)
when PEEP ≤
5 cmH2O and FiO2 ≤
0.50. Patients were considered ready for extubation if
the SpO2
was ≥
95%, VT ≥
5mL/kg, and RR remained in acceptable range for age.
The goal of the ERT was to identify
patients ready for extubation at morning rounds. We evaluated
the number of ventilator patients, ERTs performed, ERT results, and
extubation failures (need for mechanical support within 24 hours)
over a 6-month period from 10/03 to 3/04.
Results: There
were 353 ventilator patients. 210 (59%) had ERTs conducted, 38 (11%)
were extubated without being tested for extubation readiness, and
data was incomplete or unavailable for 105
(30%) patients.
There were 264 ERTs conducted on the 210 patients. Extubation
occurred in 194 (92%) patients of whom 167 (86%) were extubated after
passing their first ERT, 24 (11%) after more than 1 ERT, and 3 (2%)
were extubated despite failing the ERT. The remaining 16 (8%) who
received an ERT were extubated independent of the ERT results. The
average time from start of ERT to extubation was 5.6 ±
6.0 hours. Of the patient’s extubated
after passing their first ERT, 4 (2.0%) failed extubation.
There were 2 additional extubation failures, 1 had passed the ERT
twice, and 1 failed the ERT. 3 patients failed extubation due to
secretions, 2 patients failed for upper airway obstruction and 1
patient had lobar lung collapse.
Conclusions: Application
of the ERT on eligible patients prior to rounds was fairly good as
59% had an ERT documented. Improvements in testing and documentation
of all eligible patients are warranted. Our data suggests that
patients who pass the ERT on one attempt will likely be successfully
extubated, and that prolonged weaning may not be necessary. We will
continue to monitor the use of the ERT, evaluate the reasons for
delayed extubation and the impact of the ERT on ventilator duration.
1.
AG Randolph et al. Effect of mechanical ventilator weaning protocols
on respiratory outcomes in infants and children. JAMA 2002;288:2561.