Predictors of successful extubation in children

Objective criteria to predict extubation outcome in mechanically ventilated children are not available. Our goal was to study factors associated with extubation success and to evaluate the usefulness of the rapid shallow breathing index (RSBI) and the compliance, resistance, oxygenation, and pressure index (CROP index) in children. Data were prospectively collected on 227 mechanically ventilated children. Patients successfully extubated had significantly better lung compliance (Cdyn: 0.59 +/- 0.91 versus 0.39 +/- 0.74 ml/kg/cm H2O), higher Pao(2)/FIo(2) ratio (382.4 +/- 181.2 versus 279.8 +/- 93.9), and tower Pao, (41.3 +/- 6.7 versus 47.3 +/- 8.5 mm Hg). Spontaneous breathing parameters showed significantly lower respiratory rates (RR) (36.6 +/- 17.9 versus 52.8 +/- 23 breaths/min), larger tidal volumes (VT) (7.3 +/- 2.6 versus 4.9 +/- 1.8 ml/kg), and greater muscle strength (negative inspiratory force [NIF]: 41.8 +/- 15.4 versus 35.1 +/-: 12.5 cm H2O) in successfully extubated children. Extubation failures had higher RSBIs and lower CROP index values. A RSBI value of less than or equal to 8 breaths/ml/kg had a sensitivity of 74% and specificity of 74%, whereas a CROP value of greater than or equal to 0.15 ml/kg/breaths/min had a sensitivity of 83% and specificity of 53% for extubation success. Children failing extubation demonstrate abnormalities of respiratory function. The RSBI and CROP index are useful to predict pediatric extubation success.