Background: There is currently no standardized way to determine suitability for extubation of pediatric ICU (PICU) patients, potentially resulting in prolonged duration of mechanical ventilation. We aimed to design and implement a protocol for screening all intubated PICU patients for extubation readiness.
Methods: We adopted the quality improvement (QI) Model for Improvement with Plan-Do-Study-Act (PDSA) cycles to achieve this aim. This QI project was conducted over 11 months in a multidisciplinary PICU. Outcome measures included the (1) development of a standardized extubation readiness test (ERT) that was acceptable and safe; (2) performance of ERT on > 80% of all mechanically ventilated subjects; and (3) maintenance or reduction in mechanical ventilation duration, extubation failure (non-elective re-intubation within 48 h of extubation), and need for rescue noninvasive ventilation (NIV). Balancing measures were to ensure (1) no compromise of the subject's clinical status; and (2) acceptability of the ERT workflow by medical, nursing, and respiratory therapist (RT) teams.
Results: Four PDSA cycles were necessary to achieve the aims of this study. During the QI period, 438 subjects were admitted to the PICU. The ERT was championed by the RTs who conducted the test during office hours. ERT performance increased from 0% (baseline) to 90% (fourth PDSA cycle). Extubation failure rate after implementing ERT was reduced compared to baseline (4/31 [12.9%] vs 3/127 [2.4%], = .01), whereas need for rescue NIV (3/31 [9.7%] vs 10/127 [7.9%], = .74) and duration of mechanical ventilation (2 [1-7] d vs 1 [1-3] d, = .09) were unchanged. PICU length of stay was reduced after implementing ERT (5 [3-10] d vs 3 [1-6] d, = .01). No subject was destabilized as a result of ERT, and PICU staff found the workflow acceptable.
Conclusions: An acceptable and safe ERT protocol was implemented and found to improve outcomes in PICU subjects on mechanical ventilation.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.4187/respcare.09680 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Association between serum albumin levels at admission and clinical outcomes in pediatric intensive care units: a multi-center study.
BMC Pediatr
December 2024
Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Turkey.
Background: Albumin, a vital component in regulating human blood oncotic pressure, plays an important role in the prediction of prognosis in pediatric patients.Previous research identified significant differences in serum albumin levels of healthy and critically ill children.
Methods: The present study aims to investigate the correlation between albumin levels measured during pediatric intensive care unit(PICU) admission and clinical outcomes.
Gas transport mechanisms during high-frequency ventilation.
Respir Res
December 2024
Department of Mechanical and Product Design Engineering, Swinburne University of Technology, Hawthorn, VIC, Australia.
By virtue of applying small tidal volumes, high-frequency ventilation is advocated as a method of minimizing ventilator-induced lung injury. Lung protective benefits are established in infants, but not in other patient cohorts. Efforts to improve and extend the lung protection potential should consider how fundamental modes of gas transport can be exploited to minimize harmful tidal volumes while maintaining or improving ventilation.
View Article and Find Full Text PDFComparison of clinical characteristics and outcomes in candidaemia patients with and without COVID-19: a multicentre retrospective study.
BMC Infect Dis
December 2024
Department of Infectious Disease, Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong Ro, Donggu, Gwangju, 61469, South Korea.
Background: Invasive fungal infections have been reported as complications with significant mortality and morbidity in patients hospitalized with COVID-19. This study aimed to evaluate the clinical characteristics and outcomes of candidaemia patients with COVID-19 and to investigate the association between COVID-19 and mortality in candidaemia patients.
Methods: This retrospective study included candidaemia patients aged 18 years or older admitted to four university-affiliated tertiary hospitals in South Korea between January 1, 2020, and December 31, 2022.
Epidemiology of late-onset sepsis in Malaysian neonatal intensive care units, 2015-2020.
Malays J Pathol
December 2024
Tengku Ampuan Rahimah Hospital, Department of Paediatrics, Ministry of Health, Klang, Selangor, Malaysia.
Introduction: To determine the epidemiology of blood culture-positive late-onset sepsis (LOS, >72 hours of age) in 44 Malaysian neonatal intensive care units (NICUs).
Materials And Methods: Study Design: Multicentre retrospective observational study using data from the Malaysian National Neonatal Registry.
Participants: 739486 neonates (birthweight ≥500g, gestation ≥22 weeks) born and admitted in 2015-2020.
Feasibility and safety of ultra-low volume ventilation (≤ 3 ml/kg) combined with extra corporeal carbon dioxide removal (ECCOR) in acute respiratory failure patients.
Crit Care
December 2024
Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, PhyMedExp, INSERM U1046, CNRS UMR, University of Montpellier, 9214, Montpellier Cedex 5, France.
Background: Ultra-protective ventilation is the combination of low airway pressures and tidal volume (Vt) combined with extra corporeal carbon dioxide removal (ECCOR). A recent large study showed no benefit of ultra-protective ventilation compared to standard ventilation in ARDS (Acute Respiratory Distress Syndrome) patients. However, the reduction in Vt failed to achieve the objective of less than or equal to 3 ml/kg predicted body weight (PBW).
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!