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Updated: Aug 18, 2026
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Evaluating the Association of Extubation Readiness Testing Performance Variables With Reintubation After Pediatric
Matthew J Foglia1, Elizabeth J Thompson1,2, Jennifer I Sherwin1
1Drs. Foglia, Thompson, Sherwin, Allareddy, and Rotta and Mr. Miller are affiliated with the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
Background:
Patient performance on extubation readiness tests (ERTs) informs the decision to extubate after cardiac surgery. ERT pass criteria at our center include age-based breathing frequencies and weight-adjusted tidal volumes (VT). Evidence validating these criteria in children after cardiac surgery is limited. We hypothesized that higher breathing frequency and/or lower VT during the final ERT prior to extubation, even if meeting pass criteria, would be associated with re-intubation within 48 h.
Methods:
This was an observational, retrospective cohort study involving children <18 years of age receiving invasive mechanical ventilation for >24 h after cardiac surgery for Society of Thoracic Surgery (STAT) Mortality category ≥3 from May 2022 to April 2024. The primary outcome was extubation failure. The secondary outcome was the interval between the first passed ERT and extubation. Factors associated with re-intubation were explored using univariate and multivariable analyses.
Results:
Two hundred sixty-eight subjects met inclusion criteria with a median (interquartile range) age of 58.5 (6.1-210.2) days and weight of 4.2 (3.3-7.5) kg. Thirty (11.2%) subjects experienced extubation failure. These subjects had a higher breathing frequency during the ERT (42 [36-52] vs 36 [28-44] breaths/min, P = .01). On univariate analysis, subjects who required re-intubation were younger, had longer courses of invasive mechanical ventilation, and more frequently received preoperative invasive mechanical ventilation, delayed sternal closure, or were in a higher STAT category. Multivariable analysis revealed no association between re-intubation and breathing frequency (adjusted odds ratio [aOR] = 1.02, 95% CI: 0.99-1.06), VT (aOR = 1.0, 95% CI: 0.78-1.25), or the Rapid Shallow Breathing Index (RSBI; expressed as breathing frequency/VT) (aOR = 1.11, 95% CI: 0.96-1.27). The interval between the first passed ERT and extubation did not differ between groups (1.4 [0.5-3.6] vs 1.2 [0.4-2.4] days, P = .22).
Conclusions:
There was no association between the final ERT breathing frequency, VT, or RSBI and re-intubation within 48 h.
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