High-Risk Extubation Readiness Testing for Children With Cardiac Critical Illness.
| Autor: | Chen Yun Goh, Herng Lee Tan, Yi-Jyun Ma, Bugarin Aguilan, Apollo, Wen Cong Lee, Menon, Anuradha P., Yee Hui Mok, Ju-Ming Wong, Judith |
|---|---|
| Předmět: |
HEART disease risk factors
RISK assessment VENTILATION LOGISTIC regression analysis FISHER exact test KRUSKAL-Wallis Test CATASTROPHIC illness TREATMENT effectiveness DESCRIPTIVE statistics INTUBATION ODDS ratio ARTIFICIAL respiration EXTUBATION QUALITY assurance CONFIDENCE intervals COMPARATIVE studies DATA analysis software CHILDREN |
| Zdroj: | Respiratory Care; Sep2024, Vol. 69 Issue 9, p1108-1115, 8p |
| Abstrakt: | BACKGROUND: A protocolized extubation readiness test (ERT), including a spontaneous breathing trial (SBT), is recommended for patients who are intubated. This quality-improvement project aimed to improve peri-extubation outcomes by using a high-risk ERT protocol in intubated cardiac patients in addition to a standard-risk protocol. METHODS: After baseline data collection, we implemented a standard-risk ERT protocol (pressure support plus PEEP), followed by a high-risk ERT protocol (PEEP alone) in cardiac subjects who were intubated. The primary outcome, a composite of extubation failure and rescue noninvasive respiratory support, was compared between phases. Ventilator duration and use of postextubation respiratory support were balancing measures. RESULTS: A total of 213 cardiac subjects who were intubated were studied, with extubation failure and rescue noninvasive respiratory support occurring in 10 of 213 (4.7%) and 8 of 213 (3.8%), respectively. We observed a reduction in the composite outcome among the 3 consecutive phases (5/29 [17.2%], 10/110 [9.1%] vs 3/74 [4.1%]; P = .10), but this did not reach statistical significance. In the logistic regression model when adjusting for admission type, the high-risk ERT protocol was associated with a significant reduction of the composite outcome (adjusted odds ratio 0.20, 95% CI 0.04-0.091; P = .037), whereas the standard-risk ERT protocol was not (adjusted odds ratio 0.48, 95% CI 0.15-1.53; P = .21). This was not accompanied by a longer ventilator duration (2.0 [1.0, 3.0], 2.0 [1.0-4.0], vs adjusted odds ratio 2.0 [95% [1.0-6.0]; P = .99) or an increased use of planned noninvasive respiratory support (10/29 [35.5%], 35/110 [31.8%], vs 25/74 [33.8%]; P > .99). CONCLUSIONS: In this quality-improvement project, a high-risk ERT protocol was implemented with improvement in peri-extubation outcomes among cardiac subjects. [ABSTRACT FROM AUTHOR] |
| Databáze: | Supplemental Index |
| Externí odkaz: |
|