Extubation failure in PICU: The Preventive Strategies and Lessons Learnt

Abstract

Mechanical ventilation has always played a pivotal role in saving lives in pediatric critical care. But as indications for the same have been elaborated in literature, weaning is still a challenging task. A structured weaning protocol is required to prevent extubation failure in a critical care setting. Prolonged mechanical ventilation, extended sedative use, post-extubation stridor (PES), and diminished respiratory muscle strength are major causes of failed extubation. To tackle its impact, many new techniques, indices, and modalities are being developed. Using non-invasive ventilation for weaning, peri-extubation steroids, minimal sedation, and nutrition maintenance are some of the strategies that have been shown to improve the ventilation outcomes. Diaphragmatic ultrasonography has emerged as a new non-invasive technique to test diaphragm strength and can be used to assess readiness for successful extubation. Integrating knowledge about risk factors, applying defined tests and maneuvers, and using different parameters and ultrasonography to monitor diaphragm function can improve the chances of successful extubation.