Evaluation of predictors of weaning from mechanical ventilation in pediatric patients

Baumeister, B.; El-Khatib, Mohamad; Smith, Paul; Blumer, Jeffrey L.

doi:10.1002/(sici)1099-0496(199711)24:5<344::aid-ppul7>3.0.co;2-i

Cited by 89 publications

(65 citation statements)

References 13 publications

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“…Though the statistical analysis showed highly significant differences, this study included only 47 patients, similar to other weaning studies, 4,[34][35][36] and our results need validation in a prospective multicenter study. Our screening criteria were conservative in order to tightly control the protocol and therefore allow a better comparison of the 4 SBT predictors.…”

Section: Limitationssupporting

confidence: 68%

“…The CROP index was found to be a better predictor than RSBI in a pediatric study, 34 but CROP is less often used than RSBI, mainly because of CROP's complexity. The Hypercapnia (P aCO 2 increase of Ͼ 5 mm Hg) 7 Tachycardia (heart rate increase of Ͼ 20 beats/min) 4 Hypoxemia (P aO 2 Ͻ 60 mm Hg) 2 CORE index expresses the respiratory effort with the P Imax / P 0.1 ratio, whereas the CROP index expresses it only with P Imax .…”

Section: Discussionmentioning

confidence: 93%

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Preliminary Evaluation of a New Index to Predict the Outcome of a Spontaneous Breathing Trial

et al. 2011

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BACKGROUND:The available predictors of spontaneous-breathing-trial (SBT) success/failure lack accuracy. We devised a new index, the CORE index (compliance, oxygenation, respiration, and effort). OBJECTIVE: To compare the CORE index to the CROP index (compliance, rate, oxygenation, and pressure), airway-occlusion pressure 0.1 s after the start of inspiratory flow (P 0.1 ), and rapid shallow breathing index (RSBI) for predicting SBT success/failure in a critical care environment. METHODS: With 47 mechanically ventilated patients recovering from respiratory failure, of various causes, we prospectively examined the SBT success/failure prediction accuracy and calculated receiver operating characteristic curves, sensitivity, specificity, and likelihood ratios of CORE, CROP, P 0.1 , and RSBI. RESULTS: The specificities were CORE 0.

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Section: Limitationssupporting

confidence: 68%

Section: Discussionmentioning

confidence: 93%

Preliminary Evaluation of a New Index to Predict the Outcome of a Spontaneous Breathing Trial

et al. 2011

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“…It is also important to emphasize that the RSB was developed as a test to identify patients' readiness for a weaning trial and not as a predictor of extubation failure (5). Previous studies have evaluated the performance of RSB as an extubation index (7,8,10) and yielded contradictory results. We therefore believed it appropriate to include the RSB index as a comparator in the current study.…”

Section: Discussionmentioning

confidence: 99%

“…Studies of multivariate indices in children, such as the rapid-shallow breathing index (RSB) (respiratory rate [RR] divided by tidal volume [VT]) (5) and the CROP index (compliance, RR, oxygenation, and inspiratory pressure [PI]), however, have been limited and yielded contradictory results. We (7) and others (8,9) have shown that the predictive power of those indices in children is poor, whereas Baumeister and colleagues (10), demonstrated that the CROP index discriminated strongly between successful and unsuccessful extubation.…”

mentioning

confidence: 83%

Tension–Time Index as a Predictor of Extubation Outcome in Ventilated Children

Harikumar¹,

Egberongbe²,

Nadel³

et al. 2009

Am J Respir Crit Care Med

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Rationale: Indices that assess the load on the respiratory muscles, such as the tension-time index (TTI), may predict extubation outcome. Objectives: To evaluate the performance of a noninvasive assessment of TTI, the respiratory muscle tension time index (TTmus), by comparison to that of the diaphragm tension time index (TTdi) and other predictors of extubation outcome in ventilated children. Methods: Eighty children (median [range] age 2.1 yr [0.15-16]) admitted to pediatric intensive care units at King's College and St Mary's Hospitals who required mechanical ventilation for more than 24 hours were studied. Measurements and Main Results: TTmus, maximal inspiratory pressure, respiratory drive, respiratory system mechanics, and functional residual capacity using a helium dilution technique, the rapid shallow breathing and CROP indices (compliance, rate, oxygenation, and pressure) indexed for body weight were measured and standard clinical data recorded in all patients. TTdi was measured in 28 of the 80 children using balloon catheters. Eight children (three in the TTdi group) failed extubation. TTmus (0.199 vs. 0.09) and TTdi (0.157 vs. 0.07) were significantly higher in children who failed extubation. TTmus greater than 0.18 (n 5 80) and TTdi greater than 0.15 (n 5 28) had sensitivities and specificities of 100% in predicting extubation failure. The other predictors performed less well. Conclusions: Invasive and noninvasive measurements of TTI may provide accurate prediction of extubation outcome in mechanically ventilated children.Keywords: diaphragm; respiratory muscles; pediatric critical care; weaningPatients are extubated when assessed to be capable of sustaining spontaneous ventilation without respiratory support. Premature extubation leading to cardiorespiratory compromise necessitates reintubation and reinstitution of mechanical ventilation and increases mortality and morbidity (1), whereas prolonged ventilatory support exposes the child to increased risk of nosocomial infection and lung injury (2). Extubation failure has been reported to occur in 4 to 10% of children (3, 4), hence an accurate predictor of extubation outcome would be of significant clinical value (1).Univariate indices that examine a single aspect of physiological function often have poor predictive power probably because they do not fully reflect all the pathophysiological processes affecting extubation outcome (5). Accurate prediction is more likely using multivariate indices that integrate a number of physiological functions (6). Studies of multivariate indices in children, such as the rapid-shallow breathing index (RSB) (respiratory rate [RR] divided by tidal volume [VT]) (5) and the CROP index (compliance, RR, oxygenation, and inspiratory pressure [PI]), however, have been limited and yielded contradictory results. We (7) and others (8, 9) have shown that the predictive power of those indices in children is poor, whereas Baumeister and colleagues (10), demonstrated that the CROP index discriminated strongly between successful an...

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“…Measures of respiratory duty cycle (ratio of inspiratory time to total breath time (Ti:Ttot)) and RR were also derived from the flow signal. The RSBI was also calculated by dividing V T corrected for body weight by RR (29). The ratio of V T corrected for body weight (ml/kg) to EMGpara was also used to provide an index of NVE.…”

Section: Articlesmentioning

confidence: 99%

Parasternal intercostal electromyography: a novel tool to assess respiratory load in children

et al. 2016

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Evaluation of predictors of weaning from mechanical ventilation in pediatric patients

Cited by 89 publications

References 13 publications

Preliminary Evaluation of a New Index to Predict the Outcome of a Spontaneous Breathing Trial

Preliminary Evaluation of a New Index to Predict the Outcome of a Spontaneous Breathing Trial

Tension–Time Index as a Predictor of Extubation Outcome in Ventilated Children

Parasternal intercostal electromyography: a novel tool to assess respiratory load in children

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