Extubation in Pediatric Patients: Proactive or Passive?

Eye & ENT Hospital of Fudan University60 enrolled

Overview

Smooth extubation process can reduce the complications in recovery time. This study aimed to investigate what is the better time to extubation when children is breathing spontaneously and adequately: waiting until children have movements or wakefulness (passive extubation）or removing endotracheal tube directly (proactive tracheal extubation).

This is a randomized, controlled cross-over trial. The hypothesis of this study is that the different extubation protocol can impact recovery quality in children in post-anaesthesia care unit (PACU). Patients aged 3-7 years were randomized into two equal groups: proactive extubation (Group A) and passive extubation. At the end of surgery, sevoflurane was turned off and patients all delivered into PACU for recovery. Patient was positioned on his or her lateral side. The ventilation was switched to positive airway pressure (CPAP) mode once the patients regained spontaneous respiration. After spontaneous breathing turn to regular and sufficient（tidal volume \>6-8 ml/kg, respiratory rate \>10 times per minutes , end tidal carbon dioxide concentration \>7.19 mmHg）, the trachea tube could be removed. In Group A, patients were extubated in a light plane of anesthesia, when they are still asleep or have swallowing reflex. In Group B, tracheal extubation was performed when the patient regained consciousness, facial grimace, spontaneous eye opening, and purposeful arm movement. After extubation, 2 L/min oxygen was administered with Venturi face mask for 10 min in both groups. Patients were transported to the ward until they breathed air with a patent airway. The extubation time, recovery characteristics and respiratory complication were recorded.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

TRIPLE

Enrollment

Conditions

Cough Tracheal Extubation

Interventions

proactive extubationBEHAVIORAL

when children is breathing spontaneously and adequately in PACU,endotracheal tube was removed directly

Eligibility

Sex: ALLMin age: 3 YearsMax age: 7 Years

Medical Language ↔ Plain English

Inclusion Criteria: * American Society of Anesthesiologists physical status aged 3-7 years Exclusion Criteria: * a suspected difficult airway reactive airway disease, recent upper respiratory tract infection gastrointestinal reflux obesity (body mass index\>30 kg/m2

Locations (1)

Anesthesiology Department of Affiliated Eye and ENT Hospital, Fudan University

Shanghai, Shanghai Municipality, China

Outcomes

Primary Outcomes

Coughing

1 if a single cough occurred and saturation by pulse oximetry (SpO2) ≥95%; 2 if multiple coughs occurred and SpO2 ≥95%; 3 if multiple coughs occurred and SpO2 \<95%; and 4 if multiple coughs occurred, SpO2 \<95%, and coughing required administration of i.v . medication.

Time frame: at the time of extubation within 1 minute

Respiratory complications

the number of patients who had gagging, clenched teeth, gross purposeful movements, breath holding, laryngospasm, or desaturation to SpO2\<90%

Time frame: During the time when patients stayed in PACU after extubation, an average of 45 min

Time to spontaneous eye opening

Time frame: The time from PACU arrival to spontaneous eye opening, an average of 45 min

Time to discharge from PACU

Time frame: The time from patients arrived PACU to who was decided to discharge from PACU，an average of 1 hour

Secondary Outcomes

Time to extubation

The time of extubation after surgery

Time frame: The time from PACU arrival to tracheal extubation, an average of 30 min

End-tidal concentration of minimum effective alveolar anesthetic concentration

In percentage

Time frame: The time before patients were decided to extubate, within 1 minute

Age

In years

Time frame: 6 hours before intervention

Data from ClinicalTrials.gov

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