Background: The withdrawal of invasive mechanical ventilation (MV) within the context of withdrawal of life-sustaining measures (WLSM) is common in the intensive care unit (ICU). The method by which invasive MV is withdrawn during WLSM remains an ongoing topic of discussion and research; two methods are terminal weaning (TW) and terminal extubation (TE). Aims: To statistically describe and compare the processes of TW and TE as undertaken in two ICUs. Study Design: A secondary data analysis using data from a longitudinal retrospective chart audit. Results: A total of 78 patient charts were included. MV was withdrawn in 88.5% of patients undergoing WLSM. TW was used in 62.3% of the cases while TE was used in 37.7%. Patients who underwent TW were on average younger, had a longer ICU stay, higher respiratory support requirements, a longer duration of invasive MV, and shorter period from first change in MV parameters to patient death. Conclusion: This study highlights the nuances and complexities within MV withdrawal and WLSM in the ICU.

On a daily basis critically ill paediatric patients are admitted in the Paediatric Critical Care Unit (PCCU). Some of these paediatric patients require cardiothoracic surgery and is mechanically ventilated post-operatively. Chapter one of this study gives an orientation to this research and explains that in order to prevent ventilator associated complications and high hospitalisation costs, the mechanically ventilated paediatric patient following cardiothoracic surgery should be extubated as soon as he/she is ready. Chapter two is dedicated to the available literature on this topic and indicates that literature on extubation criteria for the mechanically ventilated paediatric patient is minimal. The methodology of this study is discussed in detail in Chapter three. Chapter four gives a detailed explanation of the research findings and the researcher included the developed clinical pathway for the extubation of the paediatric patient following cardiothoracic surgery in a private hospital in Gauteng. The relevant clinical pathway functions as a guideline and evidence-based tool in the PCCU. Lastly Chapter five gives a summary of this study and a few recommendations are made. The researcher has included a personal reflection in this Chapter. / Dissertation (MCur)--University of Pretoria, 2014. / tm2015 / Nursing Science / MCur / Unrestricted

A dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in fulfilment of requirements for the degree of Masters of Science. Johannesburg 2012 / Background: The detrimental effects of prolonged mechanical ventilation (MV) on the respiratory muscles, especially the diaphragm, are well documented and it is crucial that MV should be discontinued as soon as possible to prevent added complications and additional risks to patients with critical illness. The spontaneous breathing stage of MV can be managed as a rehabilitation and conditioning phase for the respiratory muscles due to the fact that the respiratory muscles are more active during this stage of MV. Weaning strategies that provide insufficient respiratory work, too high a respiratory muscle load or insufficient respiratory muscle rest may lead to respiratory muscle fatigue and consequently failed weaning and extubation. The aim of this research project was to develop an individualised continuous positive airway pressure (CPAP) weaning programme and test its effects on the outcomes of extubation in the adult ventilated patient. Method: An experimental, prospective, non-randomised, sequential study of two groups of subjects was performed. Forty eight subjects [group one: n =24 (control) and group two: n = 24 (intervention)], who were mechanically ventilated for longer than 48 hours, in an open adult, general intensive care unit were recruited. Subjects in the control group were weaned according to the standard weaning programme of the test setting at the time; and those in the intervention group were weaned according to an individualised CPAP programme. This weaning programme was developed utilising three principles of muscle rehabilitation namely; daily stepwise progression, sufficient rest and recovery periods and adapted to the individual needs and progression of each subject. Objective measurements such as the rapid shallow breathing index (RSBI), RSBI rate and the maximum inspiratory pressure (MIP) were used to determine the subjects in group two’s readiness for a spontaneous breathing trial. The primary outcomes assessed were time spent in the different stages of MV, rate of failure to sustain spontaneous breathing in stage 3 of MV, successful extubation and mortality rate. Results and Discussion: The difference in rate of failure to sustain spontaneous breathing between the two groups was statistically significant (p = 0.01) with 10 events of failure in group one and three in group two. The rate of successful extubation from MV between groups one and two was 70.8% and 91.7% iv respectively (p=0.52). The mortality rate was 33.3% for group one and 8.3% for group two (p = 0.02). The difference in the total time spent on MV (days) did not differ significantly (group one = 8.6 (± 0.40) days; group two = 9.3 (±0.32) days; p = 0.75). The results yielded from this study suggest that the use of a multidisciplinary team model and an individualised CPAP programme aids successful extubation from MV as the success rate was much higher in the intervention group than in the control group without adding additional time on MV. Conclusion: Results from this study showed that the implementation of an individualised CPAP programme during the spontaneous breathing stage of MV may improve the outcomes of extubation in adult ventilated patients.

Bakgrund: Den normala sväljfunktionen är en mycket komplicerad funktion, och om den inte fungerar korrekt finns det risk för ett flertal komplikationer, bland annat aspiration och/eller ofri luftväg. Dysfagi efter extubation på intensivvårdsavdelningen är ett problemområde som på senare år fått betydligt mer uppmärksamhet än tidigare. Fenomenet kan i dagsläget uppfattas som relativt outforskat. Syfte: Syftet var att beskriva intensivvårdssjuksköterskans erfarenheter kring intensivvårdspatienter med dysfagi efter extubation på intensivvårdsavdelningen. Metod: Tolv intensivvårdssjuksköterskor intervjuades med en semistrukturerad metod. Intervjuerna transkriberades och analyserades med kvalitativ innehållsanalys. Resultat: Arbetet resulterade i fem kategorier: omvårdnad kring dysfagi, erfarenhet och kunskap kring dysfagi, risker och komplikationer med dysfagi, tvärprofessionella samarbete och erfarenheten kring arbetssättet med dysfagi. Dessa kategorier mynnade ut i ytterligare tretton subkategorier. Intensivvårdssjuksköterskorna upplever att dysfagi efter extubation som något mycket jobbigt för patienten, och önskar mer kunskap samt screening-instrument för att hjälpa patienterna på bästa sätt. Slutsatser: Dysfagi tolkas av intensivvårdssjuksköterskan som en påfrestande problematik för patienten. Området är ännu relativt outforskat och därför saknas det etablerade strukturer att arbeta efter kliniskt. Intensivvårdssjuksköterskan upplever en osäkerhet kring sin egen kunskap om ämnet. Detta gör att patienten inte alltid får rätt hjälp relaterat till dysfagin.

Objetivos: determinar a taxa de falha da ventilação não invasiva (VNI) em crianças em pós operatório (PO) de cirurgia cardíaca com insuficiência respiratória (IResp) pós extubação e identificar seus fatores preditivos de sucesso. Tipo de estudo: coorte prospectivo. Local: Unidade de terapia intensiva pediátrica de três hospitais terciários de São Paulo, Brasil. Sujeitos: Pacientes consecutivos pediátricos menores que 18 anos com diagnóstico de cardiopatia congênita que foram submetidos a cirurgia cardíaca corretiva ou paliativa e apresentaram IResp em até 48 horas após a extubação sendo tratados com VNI. Intervenção: nenhuma. Métodos e resultados principais: a coleta de dados foi realizada entre 2011 e 2014, analisados 170 pacientes. Foi considerado falha da VNI a necessidade de reintubação orotraqueal em até 48 horas após o término do uso da VNI. Nenhum paciente apresentou parada cardiorrespiratória durante o uso da VNI, nem outra complicação que interrompesse seu uso. 61,8% tiveram sucesso na utilização de VNI, não necessitando de reintubação. A mediana de idade foi de 2 meses. Os sujeitos foram divididos em grupo sucesso da VNI e falha para a análise. A análise estatística foi realizada com os testes qui-quadrado, Mann-Whitney ou testes t-Student, realizada após a regressão logística univariada e multivariada para os com p < 0,05. As seguintes variáveis não apresentaram diferença estatística, entre os grupos: tempo circulação extracorpórea (p=0,669), hipertensão pulmonar (p=0,254), síndrome genética (p=0,342), RACHS-1 (p=0,097), idade (p=0,098), tempo ventilação mecânica invasiva (VMI) (p=0,186) e tempo VNI (p=0,804). O sexo masculino apresentou maior incidência de sucesso da VNI com p=0,013. Todos os parâmetros ventilatórios utilizados na VNI foram coletados e apresentaram p < 0,05. Na análise multivariada, apenas influenciaram na ocorrência de falha da VNI o gradiente de pressão mínimo (OR 1,45 com p=0,007), a saturação de pulso de oxigênio (SpO2) máxima (OR 0,88 com p=0,011) e a fração inspirada de oxigênio (FiO2) máxima (OR 1,16 com p < 0,001). Conclusão: VNI pode ser utilizada com sucesso em crianças em PO de cirurgia cardíaca que desenvolveram IResp nas 48 horas subsequentes à extubação, utilização de maior gradiente de pressão e maiores FiO2 são fatores associados com maior falha da utilização da VNI, utilização da VNI é segura sem a ocorrência de eventos adversos que impossibilitassem a utilização desta terapêutica / Objectives: To determine the rate of failure of noninvasive ventilation (NIV) in postoperative (PO) cardiac surgery in pediatric patients with respiratory failure (RF) after extubation and to identify predictive success factors. Design: prospective cohort study. Setting: Pediatric intensive care unit of three tertiary hospitals in São Paulo, Brazil. Patients: Consecutive pediatric patients under 18 years of age with diagnosis of congenital heart disease who underwent corrective or palliative heart surgery and presented RF within 48 hours after extubation and were treated with NIV. Intervention: none. Measurements and main results: data collected between 2011 and 2014, from 170 patients with 2 months median age. The need for orotracheal reintubation within 48 hours after the end of NIV was considered as NIV failure. No patient presented cardiorespiratory arrest during the use of NIV, nor another complication that interrupted its use. Overall, 61.8% were successful in the use of NIV, not requiring reintubation. Subjects were divided for analysis into successful and failed NIV groups. Statistical analysis used chi-square, Mann-Whitney or Student-t tests, performed after univariate and multivariate logistic regression, for p < 0.05. In the multivariate analysis, only the minimal pressure gradient (OR 1.45 with p = 0.007), the maximum oxygen saturation (SpO2) (OR 0.88 with p = 0.011) and the maximum inspiratory oxygen fraction (FiO2) (OR 1.16 with p < 0.001) influenced NIV failure. All ventilatory parameters used in NIV were collected and affected NIV success, with p < 0.05. The following variables did not present statistical difference between the groups: extracorporeal circulation time (p = 0.669), pulmonary hypertension (p = 0.254), genetic syndrome (p = 0.342), RACHS-1 (p = 0.097), age (p = 0.098), invasive mechanical ventilation (IMV) duration (p = 0.186) and NIV duration (p = 0.804). Conclusion: NIV can be successfully used in children in cardiac surgery postoperative who developed RF in the 48 hours following extubation. Use of higher pressure gradients and higher FiO2 associate with greater failure of NIV use. NIV use is safe, without occurrence of adverse events that prevent its use

Objetivos: determinar a taxa de falha da ventilação não invasiva (VNI) em crianças em pós operatório (PO) de cirurgia cardíaca com insuficiência respiratória (IResp) pós extubação e identificar seus fatores preditivos de sucesso. Tipo de estudo: coorte prospectivo. Local: Unidade de terapia intensiva pediátrica de três hospitais terciários de São Paulo, Brasil. Sujeitos: Pacientes consecutivos pediátricos menores que 18 anos com diagnóstico de cardiopatia congênita que foram submetidos a cirurgia cardíaca corretiva ou paliativa e apresentaram IResp em até 48 horas após a extubação sendo tratados com VNI. Intervenção: nenhuma. Métodos e resultados principais: a coleta de dados foi realizada entre 2011 e 2014, analisados 170 pacientes. Foi considerado falha da VNI a necessidade de reintubação orotraqueal em até 48 horas após o término do uso da VNI. Nenhum paciente apresentou parada cardiorrespiratória durante o uso da VNI, nem outra complicação que interrompesse seu uso. 61,8% tiveram sucesso na utilização de VNI, não necessitando de reintubação. A mediana de idade foi de 2 meses. Os sujeitos foram divididos em grupo sucesso da VNI e falha para a análise. A análise estatística foi realizada com os testes qui-quadrado, Mann-Whitney ou testes t-Student, realizada após a regressão logística univariada e multivariada para os com p < 0,05. As seguintes variáveis não apresentaram diferença estatística, entre os grupos: tempo circulação extracorpórea (p=0,669), hipertensão pulmonar (p=0,254), síndrome genética (p=0,342), RACHS-1 (p=0,097), idade (p=0,098), tempo ventilação mecânica invasiva (VMI) (p=0,186) e tempo VNI (p=0,804). O sexo masculino apresentou maior incidência de sucesso da VNI com p=0,013. Todos os parâmetros ventilatórios utilizados na VNI foram coletados e apresentaram p < 0,05. Na análise multivariada, apenas influenciaram na ocorrência de falha da VNI o gradiente de pressão mínimo (OR 1,45 com p=0,007), a saturação de pulso de oxigênio (SpO2) máxima (OR 0,88 com p=0,011) e a fração inspirada de oxigênio (FiO2) máxima (OR 1,16 com p < 0,001). Conclusão: VNI pode ser utilizada com sucesso em crianças em PO de cirurgia cardíaca que desenvolveram IResp nas 48 horas subsequentes à extubação, utilização de maior gradiente de pressão e maiores FiO2 são fatores associados com maior falha da utilização da VNI, utilização da VNI é segura sem a ocorrência de eventos adversos que impossibilitassem a utilização desta terapêutica / Objectives: To determine the rate of failure of noninvasive ventilation (NIV) in postoperative (PO) cardiac surgery in pediatric patients with respiratory failure (RF) after extubation and to identify predictive success factors. Design: prospective cohort study. Setting: Pediatric intensive care unit of three tertiary hospitals in São Paulo, Brazil. Patients: Consecutive pediatric patients under 18 years of age with diagnosis of congenital heart disease who underwent corrective or palliative heart surgery and presented RF within 48 hours after extubation and were treated with NIV. Intervention: none. Measurements and main results: data collected between 2011 and 2014, from 170 patients with 2 months median age. The need for orotracheal reintubation within 48 hours after the end of NIV was considered as NIV failure. No patient presented cardiorespiratory arrest during the use of NIV, nor another complication that interrupted its use. Overall, 61.8% were successful in the use of NIV, not requiring reintubation. Subjects were divided for analysis into successful and failed NIV groups. Statistical analysis used chi-square, Mann-Whitney or Student-t tests, performed after univariate and multivariate logistic regression, for p < 0.05. In the multivariate analysis, only the minimal pressure gradient (OR 1.45 with p = 0.007), the maximum oxygen saturation (SpO2) (OR 0.88 with p = 0.011) and the maximum inspiratory oxygen fraction (FiO2) (OR 1.16 with p < 0.001) influenced NIV failure. All ventilatory parameters used in NIV were collected and affected NIV success, with p < 0.05. The following variables did not present statistical difference between the groups: extracorporeal circulation time (p = 0.669), pulmonary hypertension (p = 0.254), genetic syndrome (p = 0.342), RACHS-1 (p = 0.097), age (p = 0.098), invasive mechanical ventilation (IMV) duration (p = 0.186) and NIV duration (p = 0.804). Conclusion: NIV can be successfully used in children in cardiac surgery postoperative who developed RF in the 48 hours following extubation. Use of higher pressure gradients and higher FiO2 associate with greater failure of NIV use. NIV use is safe, without occurrence of adverse events that prevent its use

Early extubation of cardiac surgery patients has become increasingly important. The assessment of the patient before an early extubation is crucial and the intensive care nurses (ICU nurses) in this estimation is there for very important. The aim of this study was to examine critical care nurses' knowledge of early extubation, and what view ICU nurse has about factors that affect the time to extubation of cardiac surgery patients. A quantitative approach with descriptive and comparative design was used. Selection was all ICU nurses at a thoracic intensive care unit who were clinically active in patient care. The study showed that ICU nurses had good knowledge of why an early extubation was essential. However, the knowledge about the unit’s extubation criteria was low. ICU nurses felt that the criteria for the cardiac surgery patients on the unit was adequate. The time target of 90 minutes was reasonable. No relationship existed between professional experience and knowledge of the extubation criteria or between knowledge of the criteria and need of support from colleagues in early extubation of the cardiac surgery patients. The ICU nurses considered themselves familiar with the unit’s extubation criteria but the knowledge of them was low and the majority was working according to their own criteria. The units criteria was not sufficiently visible in the unit and could contributed to the low level of knowledge and contribute to that the majority of the ICU nurses was working according to their own criteria. / Tidig extubering av hjärtkirurgipatienter har blivit allt mer viktigt, en åtgärd där intensivvårdssjuksköterskan har en viktig roll i dennes bedömning av patienten. Syftet med studien var att belysa intensivvårdssjuksköterskans kunskap om tidig extubering samt vilken syn intensivvårdssjuksköterskan har på faktorer som påverkar tiden till extubering av hjärtkirurgipatienter. Studien har en kvantitativ ansats med deskriptiv och jämförande design. Metoden som användes var en enkätundersökning. Urvalet var alla intensivvårdssjuksköterskor på en thoraxintensivvårdsavdelning som var kliniskt verksamma i patientvården. Studien visade att intensivvårdssjuksköterskor hade bra kunskap om varför en tidig extubering eftersträvas. Däremot var kunskapen låg om avdelningens extuberingskriterier. Intensivvårds-sjuksköterskorna ansåg att kriterierna för hjärtkirurgipatienterna på avdelningen var tillräck-liga och att tidsmålet på 90 minuter var rimligt. Studien visade att inget samband fanns mellan yrkeserfarenhet och kunskap om extuberingskriterierna eller mellan kunskap om kriterierna och behov av stöd av kollegor vid tidig extubering av hjärtkirurgipatienter. Intensivvårdssjuksköterskorna ansåg sig känna till avdelningens extuberingskriterier men kunskapen om avdelningens extuberingskriterier var låg och majoriteten arbetar enligt sina egna kriterier. Avdelningens extuberingskriterier var inte tillräckligt synliga på avdelningen vilket kan bidra till den låga kunskapen och bidra till att majoriteten arbetade efter egna kriterier.

The thesis titled Securing airways in pediatric patients on ARD deals with the specifics of nursing care of airways. Care of airways of children hospitalised at the Anaesthetic Resuscitation Department is an integral part of comprehensive nursing care. Each nurse must have a sufficient theoretical and practical knowledge, as well as experience to independently perform nursing care of airways of pediatric patients. Free and patent airway is a prerequisite for ensuring one of the basic life functions. The aim of the theoretical part of the thesis was to summarise the issue of securing airway in children and to focus on nursing care for airways in pediatric patients. The aim of the research was to determine the specifics of nursing care for children hospitalised at the Anaesthetic Resuscitation Department due to impaired breathing. Based on the aim of the thesis, the author set out four research questions: 1. What nursing activities are performed by nurses when securing an airway in a child? 2. How nurses treat airways of intubated children? 3. What nursing care do nurses provide for children before, during and after extubation? 4. What nursing care do nurses provide for children with a tracheostomy? In the empirical part of the thesis the author employed qualitative research. Data collection was performed by the use of individual interviews with nurses. The survey was conducted at a pediatric ICU and a children's Anaesthetic Resuscitation Department. Based on the research questions and information obtained from literature sources the author drew up the basic points for interviews with nurses. The interviews were supplemented by an observation performed on a children's Anaesthetic Resuscitation Department. Interviews and observation were complemented with two case reports of pediatric patients. The reports were processed in accordance with Henderson's model. The thesis's results show specifics and difficulties of nursing care of pediatric patients hospitalised at an Anaesthetic Resuscitation Department. The thesis maps nursing care for pediatric patients when securing airway, it focuses on intubation, tracheostomy tube, extubation, aspiration, and care for oral and nasal cavities. The objective of the thesis is to show not only the specifics of this kind of nursing care and also to demonstrate the importance of communication and emotional support to pediatric patients before, during, and after the medical intervention. The intensive nursing care is continuously improving thanks to new methods and devices. The results will be provided to the nursing management of the pediatric ICU and the children's Anaesthetic Resuscitation Department. They will also be presented at professional seminars and in professional journals.

Objetivo: avaliar a eficácia da aplicação do teste de respiração espontânea (TRE) em predizer o sucesso da extubação em crianças com cardiopatia congênita no pósoperatório de cirurgia cardíaca, comparando-se com a aplicação do protocolo de desmame atualmente utilizado em centro de terapia intensiva pediátrico de hospital terciário. Desenho do estudo: ensaio clínico prospectivo randomizado controlado Pacientes: Foram elegíveis para o estudo pacientes de 0 a 18 anos de idade, no pósoperatório de cirurgia cardíaca para correção de cardiopatias congênitas, submetidos à ventilação mecânica (VM) pós-operatória por > 12 horas. Métodos: Os pacientes foram avaliados por um médico da equipe e os considerados aptos ao desmame foram selecionados para o estudo. Os pacientes randomizados ao grupo intervenção foram submetidos ao TRE (com PS de 10 cm H2O, PEEP de 5 cm H2O e FiO2 <= 50%, durante duas horas). Este teste foi realizado com ventilação em CPAP+PS. Os pacientes do grupo controle seguiram o desmame ventilatório de acordo com o protocolo vigente no CTIP do HCFMRP/USP. O desfecho primário foi considerado o sucesso da extubação, avaliado pela necessidade ou não de reintubação nas primeiras 48 horas após a extubação. Os desfechos secundários foram a duração da internação na UTI e no hospital, a incidência de pneumonia associada à ventilação e a mortalidade. Resultados: Foram alocadas no estudo 110 crianças (54 no grupo controle e 56 no grupo intervenção). Os dados demográficos, clínicos, as características cirúrgicas e os escores de gravidade, complexidade cirúrgica e de disfunção orgânica foram semelhantes nos dois grupos. Os pacientes submetidos ao TRE comparados ao grupo controle apresentaram maior sucesso de extubação (83% vs. 68.5%, p=0,02) e menor tempo de internação no CTIP (mediana 85 h vs. 367 h, p< 0,0001), respectivamente. Não houve diferença significativa entre os grupos no tempo de internação hospitalar, incidência de pneumonia associada à ventilação e mortalidade. Conclusões: O estudo mostra que o TRE é uma importante ferramenta de avaliação de prontidão à extubação. Os pacientes que foram alocados ao grupo de intervenção apresentaram maior sucesso de extubação e menor tempo de internação na UTI. / Objective: To evaluate the efficacy of the spontaneous breathing test (SBT) in predicting the success of extubation in children with congenital heart disease in the postoperative period of cardiac surgery compared with the application of the weaning protocol currently used in a pediatric intensive care unit. Study design: randomized controlled trial. Patients: Patients 0 to 18 years of age in the postoperative period following congenital heart surgery and on, mechanical ventilation (MV) for> 12 hours were eligible for the study. Methods: Patients were evaluated by a staff physician and those considered ready for weaning were selected for the study. Patients randomized to the intervention group underwent the SBT (with PS of 10 cm H2O, PEEP of 5 cm H2O and FiO2 <= 50% for two hours). This test was performed with CPAP + PS ventilation. The patients in the control group underwent ventilator weaning according to the current protocol in the PICU. The primary endpoint was success of extubation, defined as no need for reintubation in the first 48 hours following extubation. Secondary outcomes were duration of PICU and hospital stay, incidence of ventilator-associated pneumonia, and mortality. Results: 110 children (54 in the control group and 56 in the intervention group) were included in the study. Demographic, clinical, surgical, and severity scores, surgical complexity, and organ dysfunction were similar in both groups. Patients submitted to SBT compared to the control group had greater extubation success (83% vs. 68.5%, p = 0.02) and shorter length of stay in the PICU (median 85 h vs. 367 h, p <0.0001), respectively. There was no significant difference between the groups in length of hospital stay, incidence of ventilator-associated pneumonia and mortality. Conclusions: The study shows that the SBT is an important tool for assessment of extubation readiness. Patients who were allocated to the intervention group had greater extubation success and shorter PICU stay.

Objetivo: avaliar a eficácia da aplicação do teste de respiração espontânea (TRE) em predizer o sucesso da extubação em crianças com cardiopatia congênita no pósoperatório de cirurgia cardíaca, comparando-se com a aplicação do protocolo de desmame atualmente utilizado em centro de terapia intensiva pediátrico de hospital terciário. Desenho do estudo: ensaio clínico prospectivo randomizado controlado Pacientes: Foram elegíveis para o estudo pacientes de 0 a 18 anos de idade, no pósoperatório de cirurgia cardíaca para correção de cardiopatias congênitas, submetidos à ventilação mecânica (VM) pós-operatória por > 12 horas. Métodos: Os pacientes foram avaliados por um médico da equipe e os considerados aptos ao desmame foram selecionados para o estudo. Os pacientes randomizados ao grupo intervenção foram submetidos ao TRE (com PS de 10 cm H2O, PEEP de 5 cm H2O e FiO2 <= 50%, durante duas horas). Este teste foi realizado com ventilação em CPAP+PS. Os pacientes do grupo controle seguiram o desmame ventilatório de acordo com o protocolo vigente no CTIP do HCFMRP/USP. O desfecho primário foi considerado o sucesso da extubação, avaliado pela necessidade ou não de reintubação nas primeiras 48 horas após a extubação. Os desfechos secundários foram a duração da internação na UTI e no hospital, a incidência de pneumonia associada à ventilação e a mortalidade. Resultados: Foram alocadas no estudo 110 crianças (54 no grupo controle e 56 no grupo intervenção). Os dados demográficos, clínicos, as características cirúrgicas e os escores de gravidade, complexidade cirúrgica e de disfunção orgânica foram semelhantes nos dois grupos. Os pacientes submetidos ao TRE comparados ao grupo controle apresentaram maior sucesso de extubação (83% vs. 68.5%, p=0,02) e menor tempo de internação no CTIP (mediana 85 h vs. 367 h, p< 0,0001), respectivamente. Não houve diferença significativa entre os grupos no tempo de internação hospitalar, incidência de pneumonia associada à ventilação e mortalidade. Conclusões: O estudo mostra que o TRE é uma importante ferramenta de avaliação de prontidão à extubação. Os pacientes que foram alocados ao grupo de intervenção apresentaram maior sucesso de extubação e menor tempo de internação na UTI. / Objective: To evaluate the efficacy of the spontaneous breathing test (SBT) in predicting the success of extubation in children with congenital heart disease in the postoperative period of cardiac surgery compared with the application of the weaning protocol currently used in a pediatric intensive care unit. Study design: randomized controlled trial. Patients: Patients 0 to 18 years of age in the postoperative period following congenital heart surgery and on, mechanical ventilation (MV) for> 12 hours were eligible for the study. Methods: Patients were evaluated by a staff physician and those considered ready for weaning were selected for the study. Patients randomized to the intervention group underwent the SBT (with PS of 10 cm H2O, PEEP of 5 cm H2O and FiO2 <= 50% for two hours). This test was performed with CPAP + PS ventilation. The patients in the control group underwent ventilator weaning according to the current protocol in the PICU. The primary endpoint was success of extubation, defined as no need for reintubation in the first 48 hours following extubation. Secondary outcomes were duration of PICU and hospital stay, incidence of ventilator-associated pneumonia, and mortality. Results: 110 children (54 in the control group and 56 in the intervention group) were included in the study. Demographic, clinical, surgical, and severity scores, surgical complexity, and organ dysfunction were similar in both groups. Patients submitted to SBT compared to the control group had greater extubation success (83% vs. 68.5%, p = 0.02) and shorter length of stay in the PICU (median 85 h vs. 367 h, p <0.0001), respectively. There was no significant difference between the groups in length of hospital stay, incidence of ventilator-associated pneumonia and mortality. Conclusions: The study shows that the SBT is an important tool for assessment of extubation readiness. Patients who were allocated to the intervention group had greater extubation success and shorter PICU stay.