Management of extubation failure on the paediatric intensive care unit

Abstract

Extubation failure is common in PICU especially in the current era when patients with multiple complexities can be of a significant challenge. Extubation failure is defined as inability to sustain spontaneous breathing after removal of artificial airway leading to the need for re-intubation within 48 hours of a planned extubation. The pathophysiology of extubation failure can be grouped under four categories: airway, muscular power, respiratory drive, and lung parenchymal pathologies with cardiopulmonary interactions. To achieve success and maintain extubation, it is important to identify risk factors contributing for failure and fix them, wean ventilation using appropriate weaning strategies and by stepwise process, assess readiness and extubate at the optimum time. Repeated extubation failures can also be complications increasing the risk of mortality and length of stay. Causes are diverse with clinical complexity, needing multidisciplinary team approach for a comprehensive management of extubation failure. The paediatric intensivist needs to recognize children at risk of extubation failure, make a comprehensive plan and intervene at the earliest opportunity to prevent further morbidity.