scholarly journals Use of Dexamethasone to Prevent Extubation Failure in Pediatric Intensive Care Unit: A Randomized Controlled Clinical Trial

2020 ◽  
Author(s):  
Haroldo Teófilo de Carvalho ◽  
José Roberto Fioretto ◽  
Rossano Cesar Bonatto ◽  
Cristiane Franco Ribeiro ◽  
Joelma Gonçalves Martin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Extubation Failure ◽  
Controlled Clinical Trial ◽  
Loading Dose ◽  
Randomized Controlled Clinical Trial ◽  
Mechanically Ventilated ◽  
Randomized Controlled

AbstractExtubation failure is a common event in intensive care units. Corticosteroids are effective in preventing failure in adults, but no consensus has been reached on this matter in pediatrics. We assessed the efficacy of intravenous dexamethasone in mechanically ventilated children and adolescents for more than 48 hours, with at least one risk factor for failure. Extubations were scheduled 24 hours in advance when possible, and patients were randomly assigned into two groups: one group received a loading dose followed by up to four doses of dexamethasone, and the other group received no corticosteroids. Need for reintubation and length of stay in the pediatric intensive care unit were similar in both groups, and frequency of reintubation was 12.9%.

scholarly journals RISK FACTORS FOR EXTUBATION FAILURE IN MECHANICALLY VENTILATED CHILDREN IN PEDIATRIC INTENSIVE CARE UNIT

2019 ◽  
Vol 6 (7) ◽  
pp. 379-382
Author(s):  
Supreet Khurana ◽  
Siddharth Bhargava ◽  
Puneet A Pooni ◽  
Deepak Bhat ◽  
Gurdeep Dhooria ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Extubation Failure ◽  
Mechanically Ventilated

scholarly journals Association Between Deep Sedation from Continuous Intravenous Sedatives and Extubation Failures in Mechanically Ventilated Patients in the Pediatric Intensive Care Unit

2017 ◽  
Vol 22 (2) ◽  
pp. 106-111
Author(s):  
Jennifer M. Schultheis ◽  
Travis S. Heath ◽  
David A. Turner
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Pediatric Intensive Care Unit ◽  
Deep Sedation ◽  
Pediatric Intensive Care ◽  
Extubation Failure ◽  
Mechanically Ventilated ◽  
Significant Difference

OBJECTIVE The primary objective of this study was to determine whether an association exists between deep sedation from continuous infusion sedatives and extubation failures in mechanically ventilated children. Secondary outcomes evaluated risk factors associated with deep sedation. METHODS This was a retrospective cohort study conducted between January 1, 2009, and October 31, 2012, in the pediatric intensive care unit (PICU) at Duke Children's Hospital. Patients were included in the study if they had been admitted to the PICU, had been mechanically ventilated for ≥48 hours, and had received at least one continuous infusion benzodiazepine and/or opioid infusion for ≥24 hours. Patients were separated into 2 groups: those deeply sedated and those not deeply sedated. Deep sedation was defined as having at least one documented State Behavioral Scale (SBS) of −3 or −2 within 72 hours prior to planned extubation. RESULTS A total of 108 patients were included in the analysis. Both groups were well matched with regard to baseline characteristics. For the primary outcome, there was no difference in extubation failures in those who were deeply sedated compared to those not deeply sedated (14 patients [22.6%] versus 7 patients [15.2%], respectively; p = 0.33). After adjusting for potential risk factors, patients with a higher weight percentile for age (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00–1.03), lower Glasgow Coma Score (GCS) score prior to intubation (OR 0.85; 95% CI 0.74–0.97), and larger maximum benzodiazepine dose (OR 1.93; 95% CI 1.01–3.71) were associated with greater odds of deep sedation. A higher GCS prior to intubation was significantly associated with increased odds of extubation failure (OR 1.19; 95% CI 1.02–1.39). CONCLUSIONS While there was no statistically significant difference in extubation failures between the 2 groups included in this study, considering the severe consequences of extubation failure, the numerical difference reported may be clinically important.

Cardiovascular Effects of Continuous Dexmedetomidine Infusion Without a Loading Dose in the Pediatric Intensive Care Unit

2014 ◽  
Vol 30 (8) ◽  
pp. 512-517 ◽  
Author(s):  
Brian M. Cummings ◽  
Allison S. Cowl ◽  
Phoebe H. Yager ◽  
Chadi M. El Saleeby ◽  
Erik S. Shank ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Cardiovascular Effects ◽  
Loading Dose ◽  
Dexmedetomidine Infusion

scholarly journals Post-extubation Airway Obstruction in Children: Are Steroids the Key to Prevention?

2021 ◽  
Author(s):  
Kaitlin Verdone ◽  
Christopher Watson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Airway Obstruction ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Optimal Dose ◽  
Extubation Failure ◽  
Cost Of Care ◽  
Critically Ill Children

Reintubation in the pediatric intensive care unit (PICU) increases morbidity, mortality, and the overall cost of care. Post-extubation airway obstruction (PEAO) is a potentially predictable cause of extubation failure and may be prevented by the use of corticosteroids. Defining which patients are most at risk for the development of POAE as well as the optimal dose and timing of corticosteroids for prevention is critical. We review the current literature regarding the use of corticosteroids surrounding extubation in the PICU and discuss the implications that a clear algorithm for identification and treatment of these patients would have in the care of critically ill children.

scholarly journals As-needed endotracheal suctioning protocol vs a routine endotracheal suctioning in Pediatric Intensive Care Unit: A randomized controlled trial

2018 ◽  
Vol 49 (2) ◽  
pp. 148-153
Author(s):  
Gloria Lucía Lema Zuluaga ◽  
Mauricio Fenández Laverde ◽  
Ana Marverin Correa Varela ◽  
John Jairo Zuleta Tobón
Keyword(s):  
Intensive Care Unit ◽  
Randomized Controlled Trial ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Controlled Trial ◽  
Intervention Group ◽  
Pediatric Intensive Care ◽  
Control Group ◽  
Endotracheal Suctioning ◽  
Randomized Controlled

Objective: To compare two endotracheal suctioning protocols according to morbidity, days of mechanical ventilation, length of stay in the Pediatric Intensive Care Unit (PICU), incidence of VentilatorAssociated Pneumonia (VAP) and mortality. Methods: A Pragmatic randomized controlled trial performed at University Hospital Pablo Tobón Uribe, Medellin-Colombia. Fortyfive children underwent an as-needed endotracheal suctioning protocol and forty five underwent a routine endotracheal suctioning protocol. Composite primary end point was the presence of hypoxemia, arrhythmias, accidental extubation and heart arrest. A logistic function trough generalized estimating equations (GEE) were used to calculate the Relative Risk for the main outcome. Results: Characteristics of patients were similar between groups. The composite primary end point was found in 22 (47%) of intervention group and 25 (55%) children of control group (RR= 0.84; 95% CI: 0.56-1.25), as well in 35 (5.8%) of 606 endotracheal suctioning performed to intervention group and 48(7.4%) of 649 performed to control group (OR= 0.80; 95% CI: 0.5-1.3). Conclusions: There were no differences between an as-needed and a routine endotracheal suctioning protocol. Trial Registration: ClinicalTrials.gov identifier: NCT01069185

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