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Updated: Jul 10, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
The Practice of Extubation Readiness Testing in Pediatric Cardiac Intensive Care Units: A Cross-sectional Study Based
Gul Sher1, Mehdi Hedjazi Moghari1, Kamil Abbas2
1Children's Heart Center, WVU Golisano Children's, Morgantown, West Virginia, USA.
Insights
Pediatric cardiac intensive care units show varied extubation readiness assessments. Standardizing these practices is crucial for improving outcomes in children with congenital heart disease requiring mechanical ventilation.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiology
- Respiratory Therapy
Background:
- Prolonged mechanical ventilation in pediatric congenital heart disease increases morbidity.
- Early extubation is desirable but carries risks of failure.
- Assessing extubation readiness is critical in pediatric cardiac intensive care units (CICUs).
Purpose of the Study:
- To explore current periextubation practices in pediatric CICUs.
- To identify variability in extubation readiness assessment protocols.
- To understand how providers manage patients before extubation.
Main Methods:
- A global, cross-sectional survey of pediatric CICU providers was conducted virtually.
- Email invitations were used to reach participants.
- Data on periextubation practices were collected and analyzed.
Main Results:
- Low adherence to validated sedation scales (22.3%) was observed.
- Tracheal secretions frequently led to delayed extubation (60%).
- Spontaneous breathing trials were inconsistently performed (43.7%), with high-flow nasal cannula being common (91.9%).
Conclusions:
- Significant variability exists in extubation readiness assessment across institutions.
- Despite existing guidelines, standardization of periextubation protocols remains a challenge.
- Further research is needed to determine the clinical impact of this variability on patient outcomes.
Background:
Prolonged postoperative mechanical ventilation in children with congenital heart disease is associated with increased morbidity. Although early extubation may reduce complications, the risk of extubation failure requires reliable assessment before extubation. This study explores current periextubation practices in pediatric cardiac intensive care units.
Methods:
A cross-sectional survey was conducted among pediatric cardiac intensive care unit providers globally in a virtual environment, using email.
Results:
A total of 169 providers responded with a response rate of 16.7% (169 of 1009), predominantly from North America (110 of 134, 82%) and primarily physicians (127 of 167, 76%). Only 22.3% (37 of 166) consistently use a validated sedation scale, whereas 39.8% (66 of 166) did not use one. Tracheal secretions were assessed by 90.4% (151 of 167), with 60% (100 of 166) delaying extubation due to significant secretions. An air leak test was routinely performed by 75.4% (126 of 167), and 78.7% (129 of 164) administered dexamethasone when leak was absent. A spontaneous breathing trial was regularly performed by 43.7% (73 of 167), most using continuous positive airway pressure with pressure support (137 of 166, 82.5%), typically once daily for 30-60 minutes. High-flow nasal cannula was the most commonly used noninvasive support method (147 of 160, 91.9%). Most providers defined extubation failure as reintubation within 24 or 48 hours. Providers were more likely to report a spontaneous breathing trial if they worked in transplant centers or if the patients had single-ventricle physiology.
Conclusions:
This study highlights notable differences in how extubation readiness is assessed and managed across institutions. Although guidelines exist and multiple collaborative efforts have been undertaken to standardize extubation readiness testing protocols, notable variability remains. The impact of this variability on clinical outcomes warrants further investigation.
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