Respiratory distress by upper airway obstruction (UAO) is the primary etiology of extubation failure in children hospitalized in pediatric intensive care unit (PICU). This complication may require various invasive therapeutic which increase morbi-mortality and length of hospital stay. Cuff leak test (CLT) measured prior extubation to predict post-extubation UAO has been widely used in adult. The test compared expired tidal volume with cuff inflated and cuff deflated in order to predict UAO. Despite its frequent use in PICU, his predictive value to predict UAO in children is still poorly documented. Therefore, we conducted the first multicentric, prospective study to evaluate the CLT as a predictor of post-extubation UAO in critically ill children. The Primary objective is to assess the effectiveness of CLT in predicting severe respiratory distress by UAO within 48 hours of extubation in a critically ill children.
Study Type
OBSERVATIONAL
Enrollment
900
Patient ventilated through a cuffed endotracheal tube and having a cuff leak test prior extubation
CHU Bordeaux Pellegrin
Bordeaux, France
RECRUITINGHôpital Haut-Lévêques, maladies cardio-vasculaires congénitales
Bordeaux, France
RECRUITINGHôpital Haut-Lévêques, réanimation chirurgicale cardiopédiatrique
Bordeaux, France
RECRUITINGCHU Côte de Nacre
Caen, France
RECRUITINGCHU Estaing
Clermont-Ferrand, France
RECRUITINGHôpital Raymond Poincaré
Garches, France
RECRUITINGCHU Grenoble Alpes
Grenoble, France
RECRUITINGCHU Bicêtre
Le Kremlin-Bicêtre, France
RECRUITINGCHU Jeanne de Flandres
Lille, France
RECRUITINGHôpital Femme Mère Enfant HCL
Lyon, France
RECRUITING...and 9 more locations
Respiratory distress by post-extubation upper airway obstruction (UAO)
The respiratory distress will be assessed using the Westley score. The Westley score evaluates the severity of respiratory function by assessing five factors: level of consciousness, cyanosis, stridor, air entry, and retractions. A specific point values are given for each factor, and the final score sum has a range from 0 to 17. The greater the respiratory distress the more imminent the respiratory distress. Respiratory distress will be defined by a Westley score greater than or equal to 4 with a minimum of 1 for the "stridor" item, at the initiation of at least one of the following treatments (IVC, LNHD, NIV (CPAP, BiPAP or any other mode with two pressure levels), MV(reintubation or tracheotomy)).
Time frame: within 48 hours
Cumulative incidence of return to mechanical ventilation (after re-intubation)
Time frame: within 48 hours
Risk factors of severe respiratory distress (RD)
The respiratory distress will be assessed using the Westley score. The Westley score evaluates the severity of respiratory function by assessing five factors: level of consciousness, cyanosis, stridor, air entry, and retractions. A specific point values are given for each factor, and the final score sum has a range from 0 to 17. The greater the respiratory distress the more imminent the respiratory distress. Respiratory distress will be defined by a Westley score greater than or equal to 4 with a minimum of 1 for the "stridor" item, at the initiation of at least one of the following treatments (IVC, LNHD, NIV (CPAP, BiPAP or any other mode with two pressure levels), MV(reintubation or tracheotomy)).
Time frame: within 48 hours
Proportion of patients with intravenous corticosteroid therapy (IVC)
Proportion of patients with intravenous corticosteroid therapy (IVC) in progress 12 hours prior to scheduled extubation, whether initiated for extubation or pre-extubation,
Time frame: at inclusion
Predictive score for severe respiratory distress (RD)
The respiratory distress will be assessed using the Westley score. The Westley score evaluates the severity of respiratory function by assessing five factors: level of consciousness, cyanosis, stridor, air entry, and retractions. A specific point values are given for each factor, and the final score sum has a range from 0 to 17. The greater the respiratory distress the more imminent the respiratory distress. Respiratory distress will be defined by a Westley score greater than or equal to 4 with a minimum of 1 for the "stridor" item, at the initiation of at least one of the following treatments (IVC, LNHD, NIV (CPAP, BiPAP or any other mode with two pressure levels), MV(reintubation or tracheotomy)).
Time frame: within 48 hours
Median length of stay in paediatric intensive care
Time frame: Up to 28 days
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.