[ Extubation failure predictors in the release process of invasive mechanical ventilatory support in pediatrics]

Invasive mechanical ventilation (IMV) in pediatric intensive care units (PICUs) is a ubiquitous practice; the weaning process is supported by predictors, none of which guarantees success.

To describe the weaning process from IMV and to determine the predictive factors of extubation failure (EF).

Retrospective study, patients with more than 48 h of IMV, period 11/2019 to 10/2023. The following were excluded: deceased, referred to another institution and tracheostomized patients. Demographic characteristics, ventilatory status prior to extubation (IMV and blood gas parameters), variables related to the spontaneous breathing test and post-extubation support [noninvasive ventilation (NIV)] of successful vs failed extubation groups were compared aimed at determining the existence of predictors.

510 extubation events were recorded in 445 patients, with an EF rate of 12.7%. Admission for respiratory reasons (92 vs 78%), higher respiratory rate (22 vs 20 per minute) and fraction of inspired O2 (0.32 vs 0.4) programmed on the ventilator, and use of post-extubation NIV (51 vs 24%) were significantly associated with EF. In multivariate analysis, this association persisted for higher expiratory tidal volume prior to extubation and the use of NIV post-extubation. EF resulted in more days in IMV (10 vs 7) and PICU (13 vs 9).

Higher exhaled tidal volume prior to extubation and use of NIV post-extubation were predictive factors of EF, this being associated with longer stay in IMV.