The Science Journal of the American Association for Respiratory Care

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.

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