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Updated: May 10, 2026
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Do clinical parameters predict first planned extubation outcome in the pediatric intensive care unit?
James L Laham1, Patrick J Breheny2, Amanda Rush3
1St. Mary's Hospital, PICU/Pediatrics, Richmond, VA, USA jlaham@sbcglobal.net.
Insights
Physician judgment achieved a 91% success rate for extubation readiness in the pediatric intensive care unit. Prolonged mechanical ventilation and age were key risk factors for failure, impacting length of stay and cost.
Area of Science:
- Pediatric Intensive Care Medicine
- Critical Care Medicine
- Respiratory Therapy
Background:
- Lack of evidence-based guidelines for pediatric extubation readiness.
- Current practices rely on physician judgment.
Purpose of the Study:
- Evaluate physician judgment in determining extubation readiness.
- Identify factors influencing extubation success in the PICU.
Main Methods:
- Prospective cohort study of 319 pediatric intensive care unit patients.
- Analysis of preextubation ventilator settings, blood gas results, and clinical factors.
- Evaluation of extubation success rates, length of stay, and cost.
Main Results:
- Achieved a 91% first planned extubation success rate.
- Factors for failure included prolonged mechanical ventilation, younger age, steroid use, and postextubation stridor.
- Ventilator settings and blood gases generally lacked association, except low rates in short-term ventilation.
Conclusions:
- Physician judgment yielded high success, but prolonged mechanical ventilation and age are critical risk factors.
- Caution is advised for extubation readiness in short-term ventilated patients based solely on low ventilator rates.
- Over-reliance on ventilator settings/blood gases may prolong ventilation, increasing pediatric intensive care unit length of stay and costs.
Context:
There is absence of evidence-based guidelines to determine extubation readiness in the pediatric intensive care unit (PICU).
Objective:
Evaluate our practice of determining extubation readiness based on physician judgment of preextubation ventilator settings, blood gas analysis, and other factors potentially affecting extubation outcome.
Design:
Prospective cohort study from August 2010 to April 2012.
Setting:
Academic, multidisciplinary PICU.
Patients:
A total of 319 PICU patients undergoing first planned extubation attempt.
Interventions:
None.
Measurements:
Determine the extubation success rate and evaluate factors potentially affecting extubation outcome. The PICU length of stay (LOS) and cost were also recorded. Subgroup analysis was performed based on days of mechanical ventilation (MV).
Results:
A total of 319 consecutive patients underwent first planned extubation attempt with a 91% success rate. Factors associated with extubation failure were the length of MV (P < .0001, odds ratio [OR] 2.20); age (P = .02, OR 0.54); preextubation steroids (P = .04, OR 2.40); and postextubation stridor (P < .01, OR 3.40). Ventilator settings and blood gas results had no association with extubation outcome with 1 exception, ventilator rates ≤ 8 were associated with extubation failure in patients with ≤1 day of MV. Extubation failure was associated with prolonged PICU LOS and excess cost, with failures staying 14 days longer (P < .0001) and costing 3.2 time more (P < .0001) than successes.
Conclusions:
Physician judgment to determine extubation readiness led to a first planned extubation success rate of 91%. Age and the length of MV were primary risk factors for failed extubation. In patients with ≤1 day of MV, our findings suggest that confidence in extubation readiness following weaning to low ventilator rates may not be justified. Furthermore, reliance on preextubation ventilator settings and blood gas results to determine extubation readiness may lead to unnecessary prolongation of MV, thereby increasing the PICU LOS and excess cost. These findings are hypothesis generating and require further study for confirmation.
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