title: An evaluation of extubation failure predictors in mechanically ventilated infants and children.
abstract: OBJECTIVE
  To assess the accuracy of traditional weaning indices in predicting extubation failure, and to compare their accuracy when indices are measured at the onset of a breathing trial (SBT) and at the end of the SBT before extubation.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Medical-surgical intensive care unit at a tertiary care hospital.
  
  
  METHODS
  Four hundred eighteen consecutive infants and children who received mechanical ventilation for at least 48 h and were deemed ready to undergo a SBT by their primary physician.
  
  
  METHODS
  Respiratory frequency (RR), tidal volume (V(T)), maximal inspiratory pressure (P(imax)) and frequency-to-tidal volume ratio (f/V(T)) were obtained within the first 5 min of breathing through a T-piece. The primary physicians were unaware of those measurements and the decision to extubate a patient was made by them. RR, V(T), f/V(T) were remeasured before extubation by the respiratory therapists. Extubation failure was defined as needing re intubation within 48 h after extubation. The area under the receiver operating characteristic (ROC) curve was calculated for each index as a measure of the accuracy in predicting extubation outcome.
  
  
  RESULTS
  Three hundred twenty-three patients successfully underwent the SBT and were extubated, but 48 of them (14%) required re-intubation. The ROC curve for V(T), RR, P(imax) and f/V(T) measured within the first 5 min of breathing were 0.54, 0.56, 0.57 and 0.57, respectively. The ROC curve did not increase significantly when the above indices were remeasured before extubation.
  
  
  CONCLUSIONS
  In a population which had passed SBT, the ability of the traditional weaning indices to discriminate between children successfully extubated and children re-intubated is very poor.
authors.affiliation: Unidad de Cuidados Intensivos Pediátricos, Hospital de Niños R Gutiérrez, Gallo, 1425, Buenos Aires, Argentina. jufarias@intramed.net.ar
authors.forename: J A
authors.initials: JA
authors.lastname: Farias
authors.forename: I
authors.initials: I
authors.lastname: Alía
authors.forename: A
authors.initials: A
authors.lastname: Retta
authors.forename: F
authors.initials: F
authors.lastname: Olazarri
authors.forename: A
authors.initials: A
authors.lastname: Fernández
authors.forename: A
authors.initials: A
authors.lastname: Esteban
authors.forename: K
authors.initials: K
authors.lastname: Palacios
authors.forename: L
authors.initials: L
authors.lastname: Di Nunzio
authors.forename: G
authors.initials: G
authors.lastname: Fernández
authors.forename: A
authors.initials: A
authors.lastname: Bordón
authors.forename: C
authors.initials: C
authors.lastname: Berrondo
authors.forename: G
authors.initials: G
authors.lastname: Sheehan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012129:Respiratory Function Tests; D017211:Treatment Failure; D015300:Ventilator Weaning