Document Detail

Risk factors for extubation failure in infants with severe acute bronchiolitis.
MedLine Citation:
PMID:  20196883     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate demographic characteristics, mechanical-ventilation parameters, blood gas values, and ventilatory indexes as predictors of extubation failure in infants with severe acute bronchiolitis. METHODS: We conducted a prospective observational study from March 2004 to September 2005 with consecutive infants (ages 1-12 months) with severe acute bronchiolitis and considered ready to be extubated. We calculated mean airway pressure and oxygenation index. Before extubation we measured respiratory rate, tidal volume, rapid shallow breathing index, maximal inspiratory pressure, and load/force balance. Arterial blood gases were measured 1 hour before extubation. Extubation was classified as a failure if the infant needed re-intubation within 48 hours. RESULTS: Extubation failure occurred in 6 (15%) of the 40 extubated infants. The respective median (and interquartile range) age, weight, and days of mechanical ventilation for the extubation-failure and extubation-success groups were: age 5 (3-8) months versus 4 (4-6) months (P = .87), weight 4 (3-5) kg versus 6 (5-7) kg (P < .001), and mechanical ventilation days 8 (6-23) d versus 6 (5-12) d (P = .52). There were no significant differences in arterial blood gas values or mechanical-ventilation parameters between the extubation-success and extubation-failure groups. There were statistically significant differences between the extubation-failure and extubation-success groups for 2 risk factors, weight <or= 4 kg and tidal volume <or= 4 mL/kg, when those risk factors had a large area under the curve of the receiver operating characteristic. Variables that had a large area under the curve were minute volume <or= 0.8 mL/kg/min and maximal inspiratory pressure <or= 50 cm H(2)O. Variables that had a small area under the curve were load/force balance >or= 5 and rapid shallow breathing index >or= 6.7. CONCLUSIONS: In infants with severe acute bronchiolitis the extubation process is complex because of the combined features of this disease. Pediatric studies have not definitely determined predictive factors, weaning protocols, or ventilatory predictive indexes of extubation failure risk in infants with severe acute bronchiolitis. Lower minute volume and lower maximal inspiratory pressure had large areas under the curve of the receiver operating characteristic for extubation-failure risk in infants with severe acute bronchiolitis.
C?ntia Johnston; Werther Brunow de Carvalho; Jefferson Piva; Pedro Celiny R Garcia; Marcelo Cunio Fonseca
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Respiratory care     Volume:  55     ISSN:  0020-1324     ISO Abbreviation:  Respir Care     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-03     Completed Date:  2010-05-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  328-33     Citation Subset:  IM    
Pediatrics and Children Health, Universidade Federal de S?o Paulo, Napole?o de Barros, S?o Paulo, 41040-000, Brazil.
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MeSH Terms
Acute Disease
Body Weight
Bronchiolitis / therapy*
Infant, Newborn
Intensive Care Units, Pediatric
Prospective Studies
ROC Curve
Respiration, Artificial
Respiratory Function Tests
Risk Factors
Severity of Illness Index
Ventilator Weaning / adverse effects*

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