Pressure-assisted ventilation and its role in extubation facilitation in the pediatric intensive care unit: A two-year retrospective analysis of outcomes and predictors

Background: Extubation failure remains a significant complication in pediatric intensive care, associated with prolonged mechanical ventilation, increased infection risk, and extended hospital stays. Pressure-assisted ventilation modes are commonly used to facilitate weaning, but real-world effectiveness data from our region are limited.
Objective: To determine extubation success rates in children receiving pressure-assisted ventilation, identify predictors of successful extubation, and compare outcomes with other weaning approaches.
Methods: A retrospective chart review of children aged 1 month to 14 years admitted to the PICU at Queen Rania Abdullah Hospital for Children (January 2024–December 2025) who required invasive mechanical ventilation for >24 hours. Extubation success was defined as remaining free of invasive ventilation for 72 hours. Multivariate logistic regression identified independent predictors.
Results: Among 187 children (mean age 4.2±3.8 years; 58.3% male), overall extubation success rate was 78.1% (146/187). Patients weaned with pressure-assisted ventilation (n=124) had significantly higher success rates compared to those weaned with other modes (84.7% vs. 65.1%, p=0.002). Independent predictors of success included: pressure-assisted ventilation use (aOR=3.12, 95% CI: 1.48–6.58, p=0.003), lower PRISM III score (aOR=0.89 per point, 95% CI: 0.83–0.95, p<0.001), higher PaO2/FiO2 ratio (aOR=1.15 per 10-point increase, 95% CI: 1.06–1.25, p=0.001), lower PaCO2 (aOR=0.96 per mmHg, 95% CI: 0.93–0.99, p=0.008), and higher hemoglobin (aOR=1.24 per g/dL, 95% CI: 1.02–1.51, p=0.032). Patients failing extubation had longer PICU stays (18.4±8.6 vs. 8.2±4.5 days, p<0.001) and higher VAP rates (26.8% vs. 6.2%, p<0.001).
Conclusion: Pressure-assisted ventilation is associated with significantly higher extubation success rates in critically ill children. Pre-extubation gas exchange parameters and illness severity scores are important predictors. These findings support preferential use of pressure support during weaning.