Evaluation of Extubation Criteria in Children With Upper Respiratory Infection (URI)

Study Overview
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Brief Summary
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The investigators are currently completing a data collection to try to optimize pediatric patients' preoperative screening, in the setting of an upper respiratory infection.

Detailed Description
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The objectives of this study are to evaluate various extubation criteria and their predictive value for successful extubation in non-cardiac surgical procedures. To evaluate the predictive value of room air oxygen and an original preoperative URI questionnaire in pediatric patients with URI or URI symptoms.

Official Title
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A Prospective Observational Study Evaluating Extubation Criteria in Children Less Than 8 Years of Age With Upper Respiratory Infection Undergoing Outpatient or Day Hospital Based Surgery

Conditions
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Upper Respiratory Tract Infections

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All study participants must be undergoing general anesthesia and surgery with an endotracheal tube The URI group will be participants with a score of at least 3 on our pre-operative URI survey, with planned airway instrumentation with an endotracheal tube (ETT) for their surgical procedure who are to be discharged same day or on postoperative day 1. The non URI group will be participants undergoing elective procedures with no URI symptom or recent URI. Defined as no URI or allergy symptom within the past 6 weeks and a score of 1 or less on the URI survey, with planned airway instrumentation with an ETT for their surgical procedure who are to be discharged same day or on postoperative day 1. Exclusion Criteria: History of home oxygen use or ventilator dependence, Patients undergoing emergent procedures. Patients with cyanotic congenital heart disease. Patients receiving a surgical procedure where the duration of post procedure admission is anticipated to be greater or equal to 2 postoperative days. Patients undergoing anesthesia for imaging procedures alone. Patients who are extubated deep intentionally. Patients intended to be managed with supraglottic airway. Patients undergoing total IV anaesthesia (TIVA).

Ages Eligible for Study
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Maximum Age: 7 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| URI group<br>This group includes participants <8 years of age undergoing elective procedures with a score of at least 3 on our pre-operative URI survey. | |
| non-URI group<br>This group includes participants <8 years of age undergoing elective procedures with no URI symptoms or recent URI. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The rate of successful extubation in children with at least 3 of the five criteria present | The 5 criteria (facial grimace, eye opening, conjugate gaze, purposeful movement, and tidal volume > 5 cc/kg) | Day 1 | 
| Rate of participants with an extubation requiring intervention | The quality of extubation will be graded as successful, intervention required or major intervention required | Day 1 | 
| Rate of participants with an extubation requiring major intervention | The quality of extubation will be graded as successful, intervention required or major intervention required | Day 1 | 
| Rate of participants with a successful extubation | The quality of extubation will be graded as successful, intervention required or major intervention required | Day 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of on time and anticipated discharge from the hospital |  | Up to 5 days after discharge | 
| Rate of patients seeking additional care following discharge for respiratory related symptoms |  | Up to 5 days after discharge | 
| Preoperative room air oxygen saturation |  | Day 1 | 
| Rate of extubation success per the number of factors present at time of extubation | Rate of success at the presence of 3 to 6 predictors (eye opening, facial grimace, purposeful movement, conjugate gaze, tidal volume > 5 cc/kg, and ETCO2<56 mmHg) at time of extubation | Day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Extubation criteria, Pediatric Anesthesia, Outpatient surgery