The Practice of Extubation Readiness Testing in Pediatric Cardiac Intensive Care Units: A Cross-sectional Study Based on an Electronic Survey

<h2>Abstract:</h2><h3>Background</h3> Prolonged postoperative mechanical ventilation in children with congenital heart disease is associated with increased morbidity. While early extubation may reduce complications, the risk of extubation failure requires reliable assessment before extubation. This study explores current peri-extubation practices in pediatric cardiac Intensive Care Units (CICU). <h3>Methods</h3> A cross-sectional survey was conducted among CICU providers globally in a virtual environment, utilizing email. <h3>Results</h3> A total of 169 providers responded with a response rate of 16.7% (169/1009), predominantly from North America (110/134, 82%) and primarily physicians (127/167, 76%). Only 22.3% (37/166) consistently use a validated sedation scale, while 39.8% (66/166) did not use one. Tracheal secretions were assessed by 90.4% (151/167), with 60% (100/166) delaying extubation due to significant secretions. Air leak test was routinely performed by 75.4% (126/167), and 78.7% (129/164) administered dexamethasone when leak was absent. A spontaneous breathing trial (SBT) was regularly performed by 43.7% (73/167), most using CPAP with pressure support (137/166, 82.5%), typically once daily for 30-60 minutes. HFNC was the most commonly used non-invasive support method (147/160, 91.9%). Most providers defined extubation failure as reintubation within 24 or 48 hours. Providers were more likely to report SBT if they worked in transplant centers or if the patients had single-ventricle physiology. <h3>Conclusions</h3> This study highlights notable differences in how extubation readiness is assessed and managed across institutions. While guidelines exist and multiple collaborative efforts have been undertaken to standardize extubation readiness testing protocols, notable variability remains. The impact of this variability on clinical outcomes warrants further investigation.