Association of Extubation Timing and Treatment Failure After Successful Extubation Readiness Trial in Pediatric...

Protocolized mechanical ventilation weaning and extubation readiness trials (ERTs) reduce mechanical ventilation duration, but the optimal timing of extubation after a successful ERT remains unclear. We aimed to assess whether early extubation-defined as occurring within 6 h of passing ERT-is associated with treatment failure, defined as respiratory support escalation or re-intubation within 48 h. We hypothesized that early extubation would not increase treatment failure.

This was a retrospective cohort study of subjects (<18 years) who underwent mechanical ventilation and were extubated after a successful ERT between January 1, 2021, and July 10, 2023, at a single quaternary care pediatric ICU (PICU). The primary exposure was extubation timing, dichotomized as early (<6 h) or late (≥6 h) after successful ERT. The primary outcome was treatment failure, defined as re-intubation or escalation of planned postextubation respiratory support within 48 h. We compared groups using Wilcoxon rank-sum and chi-squared testing. We used univariable and inverse probability of treatment weighting (IPTW) with a doubly robust outcome model to estimate the association between extubation timing and treatment failure. Secondary outcomes included extubation failure, mechanical ventilation duration, and ICU stay.

Among 261 subjects, 102 were extubated early (median 2 h post-ERT, interquartile range [IQR] 0-3) and 159 late (median 17 h, IQR 10-35, P < .01). Age, maximal oxygen saturation index, preadmission respiratory functional status, and PELOD-2 were not significantly different between the 2 groups. Early extubation was not associated with increased treatment failure in univariable (odds ratio [OR] 1.10, 95% CI 0.55-2.20) or IPTW analysis (adjusted OR 1.30, 95% CI 0.66-2.57). Early extubation was associated with reduced postextubation ICU stay (55.5 vs 98.5 h, P < .01).

Early extubation was associated with decreased mechanical ventilation duration and ICU stay and not associated with treatment failure or re-intubation.