Introduction
In essence, Mechanical Ventilation (MV) aids in supporting critically ill patients in maintaining adequate gas alveolar. Pediatrics patients admitted to the intensive care units in need of the therapy ranges between 30% and 64%. Despite the benefits derived from using this method, some complication emerges at the end of the process when it is employed in premature babies. Primarily, the therapy may lead to lung damage, dysfunction of the right ventricle, and pneumonia. Extubation occurs when a patient can maintain efficient gas exchange without being sustained by the ventilator or when requiring minimum support. Notably, ventilator disconnection comprises of two procedures that include progressive decline, often referred as weaning, and withdrawal of the endotracheal tube, which is known as extubation. To enhance success in extubation predictors associated with the ability to guard the airwave, patency of the upper respiratory tract and management of secretion ought to be present.
Extubation failure (EF) occurs when there is a need for reintubation and restoration of MV within the first 24-72 hours after the endotracheal tube is removed. Averagely, an EF rate of 12.5% in adults have been reported while in pediatrics the rate varies between 4.9% and 29%. It has been difficult to determine an optimal EF rate. However, evidence shows that 62.5% of 136 unplanned extubations did not need reintubation and a significant number of children would be reinitiated before the planned time (Valenzuela, Araneda, & Cruces, 2016). High EF rate value is an indicator of early extubation that is linked to possible catastrophic morbidity. As such, before performing extubation and commencing the weaning procedure the objectives and reproducible criteria should be determined.
Discussion
Machine learning may be described as the process, which involves the gradual withdrawal of respiratory support to enhance spontaneous breathing in a bid to enable a patient to be responsible for a tolerable gas exchange. The introduction of spontaneous breathing trial in patients reduces the duration and complications linked to MV thereby decreasing health care costs. A study conducted recently in 294 children being given MV for more than 24 hours implementing a daily assessment strategy combined with spontaneous breathing trial (SBT) had a reduction in the period of mechanical ventilation devoid of raising EF rate (Valenzuela et al., 2016). Studies indicate that adult patients have shown that amid 60% and 80% patients under MV can be smoothly extubated after undergoing successful tolerance of spontaneous breathing trial. The common methods of SBT are continuous positive pressure airway, T-tube, and pressure maintenance. The choice of the method to be utilized in children depends on the experience of the medic.
Principally, the use of CPAP and T-tube in children and adults found no difference in EF rate in numerous studies (Valenzuela et al., 2016). The capacity to sustain spontaneous breathing when weaning usually depends on central respiratory control as well as the capability of respiratory strength. Among the many predictors of extubation failure studied in adults, only five depicted reserved capacity to predict weaning from mechanical ventilation. EF in adults has been associated with augmented duration of mechanical ventilation, deaths, ICU stays among other adverse effects. If an EF is faced in pediatric and neonates due to upper airway obstruction, prophylactic management of corticosteroids helps reduce the occurrence of post-extubation stridor.
Conclusion
Both extubation and weaning are a necessary treatment procedure in assisting patients with respiratory ailments. Daily suspension of sedatives reduces the duration of MV. Spontaneous breathing trial, daily evaluation of specific and functional conditions aids in the early identification of patients appropriate for weaning from MV. Proper performance of these procedures reduces the EF rate.
References
Valenzuela, J., Araneda, P., & Cruces, P. (2016). Weaning from mechanical ventilation in paediatrics. State of the art. Archivos De Bronconeumología (English Edition), 50(3), 105-112. http://dx.doi.org/10.1016/j.arbr.2014.02.001
