Evidence map›Paper›PMID 35550608›Full record

ArticlePediatric research2023

Pediatric ventilation liberation: evaluating the role of endotracheal secretions in an extubation readiness bundle.

Jeremy M Loberger, Ryan M Jones, Adeline S Phillips, Jeremy A Ruhlmann, A K M Fazlur Rahman, Namasivayam Ambalavanan, Priya Prabhakaran

Abstract read
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In one paragraph

Article in Pediatric research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.9field-weighted citation impact, top 26% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 6 citations in OpenAlex.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Jeremy M LobergerDivision of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA. jloberger@uabmc.edu.ORCID 0000-0002-9907-3458
Ryan M JonesDepartment of Respiratory Therapy, Children's Hospital of Alabama, Birmingham, AL, USA.
Adeline S PhillipsDepartment of Nursing Services, Children's Hospital of Alabama, Birmingham, AL, USA.
Jeremy A RuhlmannPediatric Residency Program, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
A K M Fazlur RahmanDepartment of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
Namasivayam AmbalavananDivision of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
Priya PrabhakaranDivision of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
University of Alabama at Birmingham · USChildren's of Alabama · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAn evidence gap exists regarding the role of endotracheal secretions in pediatric extubation decisions. This study aims to evaluate whether endotracheal secretion burden independently correlates with pediatric extubation failure.

methodsThis is a single-center, prospective cohort study of children aged <19 years requiring intubation. Nurses (RN) and respiratory therapists (RT) independently used a novel secretion assessment score focusing on secretion volume, character, and trend. We hypothesized that the RN and RT secretion scores would not correlate with extubation outcome and inter-rater reliability would be poor.

resultsRN secretion character sub-score (OR 3.3, 95% CI 1.1-11.1, p = 0.048) was independently associated with extubation failure. RN and RT inter-rater reliability was poor (correlation 0.385, 95% CI 0.339-0.429, p < 0.001). A failure prediction model incorporating the RN secretion character sub-score as well as indication for mechanical ventilation and spontaneous breathing trial result demonstrated an area under the receiver operating curve of 0.817 (95% CI 0.730-0.904, p < 0.001).

conclusionsIn the general pediatric population, the RN assessment of endotracheal secretion character was independently associated with extubation failure. A model incorporating indication for mechanical ventilation, spontaneous breathing result, and RN assessment of endotracheal secretion character demonstrated reasonable accuracy in predicting failure in those clinically selected for extubation. IMPACT: Development of comprehensive and sensitive extubation readiness bundles are key to balancing the competing risks of prolonged invasive mechanical ventilation duration and extubation failure. Evidence for clinical factors linked to extubation outcomes in children are limited. Endotracheal secretion burden is a common factor considered but has not been studied. This study supports a role for endotracheal secretion burden, as assessed by the bedside nurse, in extubation readiness bundles. Inter-rater reliability with respiratory therapists was poor. A model incorporating other key factors showed good discrimination for extubation outcome and sets the stage for prospective evaluation in the general population and diagnosis-specific subgroups.

Indexed as

Airway ExtubationRespiration, ArtificialChildHumansLungProspective StudiesReproducibility of Results

Identifiers

PMID35550608
OpenAlexW4280511556

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.