The use of extubation readiness parameters: a survey of pediatric critical care physicians.

Background: The pediatric literature addressing extubation readiness parameters and strategies to wean from mechanical ventilation is limited.

Methods: We designed a survey to assess the use of extubation readiness parameters among pediatric critical care physicians at academic centers in the United States.

Results: The overall response rate was 44.1% (417/945). The majority of respondents check for air leak and the amount of tracheal secretions. Fewer respondents use sedation score, the rapid shallow breathing index, or the airway-occlusion pressure 0.1 s after the start of inspiratory flow prior to extubation. The majority perform a spontaneous breathing trial with pressure support. The majority consider 30 cm H2O as the upper limit of an air leak test, and the need for endotracheal suctioning once every 2-4 hours as acceptable for extubation. In preparation for termination of mechanical ventilation the majority daily wean the ventilator rate and/or the pressure support instead of conducting a spontaneous breathing trial.

Conclusions: Most pediatric critical care physicians reported assessing extubation readiness by checking air leak and suctioning need, and less often consider or perform sedation score or the rapid shallow breathing index.