Newly Published
Editorial Views  |   August 2019
Adding Science to the Decision to Extubate Children
Author Notes
  • From the Division of Pediatric Anesthesiology, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri.
  • Accepted for publication July 9, 2019.
    Accepted for publication July 9, 2019.×
  • Competing Interests: The author is not supported by, nor maintains any financial interest in, any commercial activity that may be associated with the topic of this article.
    Competing Interests: The author is not supported by, nor maintains any financial interest in, any commercial activity that may be associated with the topic of this article.×
  • Correspondence: Address correspondence to Dr. Murray: murrayd@wustl.edu
Article Information
Editorial Views / Airway Management / Pediatric Anesthesia
Editorial Views   |   August 2019
Adding Science to the Decision to Extubate Children
Anesthesiology Newly Published on August 5, 2019. doi:10.1097/ALN.0000000000002921
Anesthesiology Newly Published on August 5, 2019. doi:10.1097/ALN.0000000000002921
Practitioners develop expertise in deciding when to extubate children through experience. The clinical acumen to make this decision is difficult to learn and is a skill that many consider more art than science. In this issue of Anesthesiology, Templeton et al. report the relationship between a number of clinical signs frequently used by practitioners to make a decision to extubate children and how these signs correlate with “success.”1  One of the most important contributions of the study is that by applying the signs selected for extubation “readiness,” the less experienced practitioner could acquire the expertise in deciding when to extubate more quickly and with a lower frequency of, as this study reports, either the need for a “major” or “minor” airway intervention after extubation.1  A second important finding of Templeton et al.’s study is that children who exhibited more of the selected clinical signs used to guide extubation had a greater likelihood of successful extubation, suggesting the utility of the cues selected by the authors to include in their study design. Finally, the study identified additional signs (elevated end-tidal carbon dioxide) and perioperative factors (upper respiratory infection and midazolam premedication) that, when present, impact extubation success.1