Mechanical ventilation is a frequently used lifesaving intervention in pediatric ICUs. Mechanical ventilation is used to treat a variety of disease processes affecting children and/or to help them recover from complex surgical procedures. However, mechanical ventilation is not free of complications and associated morbidities (eg, ventilator-induced lung injury, ventilator-associated pneumonia, airway injuries, and need for sedation with all the associated comorbidities);1-3 thus it is important for pediatric critical care providers to identify as soon as possible when a patient could be liberated from mechanical ventilation. This, however, needs to be balanced with the risk of premature extubation and need for re-intubation, since the latter is also associated with increased morbidity and mortality.4
Systematic extubation readiness testing (ERT) with the inclusion of a spontaneous breathing trial (SBT) is one of the employed methods to achieve the desired balance between duration of mechanical ventilation and extubation failure.5 There is some confusion in the literature regarding the definition of an ERT versus an SBT. In general, an SBT assesses the ability of a patient to maintain adequate respiratory function with minimal or no ventilator support (while still intubated). An ERT is a more comprehensive assessment that includes not only an SBT but evaluates other components of extubation readiness such as the presence of airway reflexes, risk of upper-airway obstruction, level of sedation, hemodynamic stability, and planned procedures.
Over the last few years, there seems to be increased use of …
Correspondence: Martin K Wakeham MD; e-mail: mwakeham{at}mcw.edu
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