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Updated: Jun 15, 2026
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Risk factors for extubation failure in infants with severe acute bronchiolitis
Cíntia Johnston1, Werther Brunow de Carvalho, Jefferson Piva
1Pediatrics and Children Health, Universidade Federal de São Paulo, Napoleão de Barros, São Paulo, 41040-000, Brazil. cintia.johnston@terra.com.br
Insights
Predicting extubation failure in infants with severe acute bronchiolitis is complex. Lower minute volume and maximal inspiratory pressure were identified as key indicators of extubation failure risk.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
Background:
- Severe acute bronchiolitis often requires mechanical ventilation in infants.
- Extubation failure in these infants can lead to prolonged hospitalization and increased morbidity.
- Predictive factors for successful extubation remain unclear in this population.
Purpose of the Study:
- To identify demographic characteristics, mechanical ventilation parameters, blood gas values, and ventilatory indexes that predict extubation failure in infants with severe acute bronchiolitis.
- To evaluate the utility of various clinical and physiological measures in assessing extubation readiness.
Main Methods:
- Prospective observational study of 40 infants (1-12 months) with severe acute bronchiolitis ready for extubation.
- Measurement of respiratory rate, tidal volume, rapid shallow breathing index, maximal inspiratory pressure, load/force balance, and arterial blood gases before extubation.
- Calculation of mean airway pressure and oxygenation index.
- Extubation failure defined as re-intubation within 48 hours.
Main Results:
- Extubation failure occurred in 15% (6/40) of infants.
- Infants who failed extubation were significantly lighter (median weight 4 kg vs 6 kg) and had a lower tidal volume (<= 4 mL/kg).
- Lower minute volume (<= 0.8 mL/kg/min) and lower maximal inspiratory pressure (<= 50 cm H2O) were significant predictors of extubation failure, indicated by large areas under the receiver operating characteristic curve.
Conclusions:
- The extubation process in infants with severe acute bronchiolitis is complex due to the disease's multifaceted nature.
- Current pediatric studies have not definitively established predictive factors or weaning protocols for extubation failure in this group.
- Lower minute volume and maximal inspiratory pressure are significant predictors of extubation failure risk in infants with severe acute bronchiolitis.
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
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.
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