CHEST
Clinical Investigations in Critical CareExtubation Failure in a Large Pediatric ICU Population
Section snippets
Materials and Methods
This retrospective chart review was approved by the HumanSubject Protection Committee. A database listing all patients requiringmechanical ventilation in the pediatric ICU (PICU) at the University of California, Los Angeles between July 1, 1996, and June 30, 1998, wascross-referenced with a list of all dates of intubations performed. Charts were reviewed of all patients requiring reintubation with in72 h of having been extubated.
Forty-one percent of the patient population at the University of
Results
There were 632 patients requiring mechanical ventilation duringthe period under review. Of these, 70 died with out ever having beenextubated, leaving 562 patients. Fourteen patients were unintentionallyextubated, leaving 548 patients in the study. Only the first attempt atextubation was included in the analysis. The mean age of the group(± SD) was 52.4 ± 61.4 months, with a median of 22.6 months. Meannumber of ventilator days before extubation was 6.5 ± 17.1 days, with a median of 2 days.
Of the
Discussion
Many factors influence a patient's ability to tolerateextubation. The ability to maintain adequate gas exchange is affectedby central inspiratory drive, respiratory muscle strength, and theworkload placed on the muscles of respiration.91718 Thepositive and negative predictive values of physicians' clinicaljudgment alone in predicting extubation outcome in adult patients wasfound to be 50% and 67%, respectively.19 The predictiveaccuracy of direct measurements of pulmonary function have
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