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Tests and Indices Predicting Extubation Failure in Children: A Systematic Review and Meta-analysis.
Ng, Priscilla; Tan, Herng Lee; Ma, Yi-Jyun; Sultana, Rehena; Long, Victoria; Wong, Judith J-M; Lee, Jan Hau.
Afiliación
  • Ng P; Duke-NUS Medical School, Singapore, Singapore.
  • Tan HL; Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
  • Ma YJ; Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
  • Sultana R; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.
  • Long V; Duke-NUS Medical School, Singapore, Singapore.
  • Wong JJ; Duke-NUS Medical School, Singapore, Singapore.
  • Lee JH; Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
Pulm Ther ; 9(1): 25-47, 2023 Mar.
Article en En | MEDLINE | ID: mdl-36459328
INTRODUCTION: There is lack of consensus on what constitutes best practice when assessing extubation readiness in children. This systematic review aims to synthesize data from existing literature on pre-extubation assessments and evaluate their diagnostic accuracies in predicting extubation failure (EF) in children. METHODS: A systematic search in PubMed, EMBASE, Web of Science, CINAHL, and Cochrane was performed from inception of each database to 15 July 2021. Randomized controlled trials or observational studies that studied the association between pre-extubation assessments and extubation outcome in the pediatric intensive care unit population were included. Meta-analysis was performed for studies that report diagnostic tests results of a combination of parameters. RESULTS: In total, 41 of 11,663 publications screened were included (total patients, n = 8111). Definition of EF across studies was heterogeneous. Fifty-five unique pre-extubation assessments were identified. Parameters most studied were: respiratory rate (RR) (13/41, n = 1945), partial pressure of arterial carbon dioxide (10/41, n = 1379), tidal volume (13/41, n = 1945), rapid shallow breathing index (RBSI) (9/41, n = 1400), and spontaneous breathing trials (SBT) (13/41, n = 5652). Meta-analysis shows that RSBI, compliance rate oxygenation pressure (CROP) index, and SBT had sensitivities ranging from 0.14 to 0.57. CROP index had the highest sensitivity [0.57, 95% confidence interval (CI) 0.4-0.73] and area under curve (AUC, 0.98). SBT had the highest specificity (0.93, 95% CI 0.92-0.94). CONCLUSIONS: Pre-extubation assessments studied thus far remain poor predictors of EF. CROP index, having the highest AUC, should be further explored as a predictor of EF. Standardizing the EF definition will allow better comparison of pre-extubation assessments.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Clinical_trials / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Idioma: En Revista: Pulm Ther Año: 2023 Tipo del documento: Article País de afiliación: Singapur Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Clinical_trials / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Idioma: En Revista: Pulm Ther Año: 2023 Tipo del documento: Article País de afiliación: Singapur Pais de publicación: Estados Unidos