Respiratory Therapist-Driven Extubation Readiness Testing in a Single Pediatric ICU

Area of Science:

• Pediatric critical care medicine
• Quality improvement methodologies
• Mechanical ventilation management

Background:

• Lack of a standardized extubation readiness test (ERT) in pediatric intensive care units (PICUs) can lead to prolonged mechanical ventilation.
• Development and implementation of a novel ERT protocol aimed to standardize extubation suitability assessments for intubated PICU patients.

Purpose of the Study:

• To design and implement a safe and acceptable ERT protocol for PICU patients.
• To evaluate the impact of the ERT on extubation failure rates, duration of mechanical ventilation, need for noninvasive ventilation, and length of PICU stay.

Main Methods:

• Quality Improvement (QI) Model for Improvement with Plan-Do-Study-Act (PDSA) cycles over 11 months.
• Development of a standardized ERT, aiming for >80% performance in mechanically ventilated subjects.
• Monitoring of extubation failure, rescue noninvasive ventilation (NIV) use, mechanical ventilation duration, and PICU length of stay.

Main Results:

• Four PDSA cycles led to 90% ERT performance.
• Extubation failure rate decreased significantly (12.9% to 2.4%, P=.01).
• PICU length of stay was reduced (5 days to 3 days, P=.01), while ventilation duration and NIV use remained unchanged.

Conclusions:

• An acceptable and safe ERT protocol was successfully implemented in a multidisciplinary PICU.
• The ERT protocol improved patient outcomes by reducing extubation failure and length of stay.
• The standardized ERT workflow was acceptable to medical, nursing, and respiratory therapist teams.