Inspiratory pressure/maximal inspiratory pressure: does it predict successful extubation in critically ill infants and children?

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

doi:10.1007/bf01712248

Cited by 38 publications

(30 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The current study is the first one to report those findings in adult patients in children. The extubation failure rate within 48 h after extubation that we found is very similar to that reported in infants and children, which has ranged from 16 to 22 % [6,13].…”

Section: Discussionsupporting

confidence: 77%

See 1 more Smart Citation

Weaning from mechanical ventilation in pediatric intensive care patients

Farias¹,

Alía²,

Esteban³

et al. 1998

Intensive Care Med

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 77%

“…There is little information about weaning parameters in mechanically ventilated children [6,12,13]. It is possible that the accuracy of indices predicting weaning failure substantially differs according to what these indices are predicting, whether it is the failure of a weaning attempt or the need for reintubation.…”

Section: Introductionmentioning

confidence: 99%

Weaning from mechanical ventilation in pediatric intensive care patients

Farias¹,

Alía²,

Esteban³

et al. 1998

Intensive Care Med

View full text Add to dashboard Cite

show abstract

“…The probability of extubation success after a successful SBT also remains high (negative predictive values <0.50) despite the presence of a negative test (e.g., a frequency-tidal volume ratio >105 breaths·l·min) [10]. In some paediatric series, weaning parameters have appeared more promising but their predictive value for extubation outcome still remains uncertain [91,93,94,95,96]. The effect of measuring parameters at the end of a successful SBT on prediction of extubation outcome has not been adequately investigated.…”

Section: Weaning Parametersmentioning

confidence: 99%

Decision to extubate

2002

View full text Add to dashboard Cite

The need for reintubation within 24-72 h of planned extubation is a common event, occurring in 2-25% of extubated patients. Risk factors for extubation failure include being a medical, multidisciplinary or paediatric patient; age >70 years; a longer duration of mechanical ventilation; use of continuous intravenous sedation; and anaemia (haemoglobin <10 g/dl or haematocrit <30%) at the time of extubation. The pathophysiology of extubation failure can be distinct from that seen with weaning failure and includes upper airway obstruction, inadequate cough, excess respiratory secretions, encephalopathy, and cardiac dysfunction. Extubation failure prolongs the duration of mechanical ventilation, increases the length of ICU and hospital stay, increases the need for tracheostomy, and is associated with a higher hospital mortality. Great emphasis has been placed on accurately predicting extubation outcome because extubation delay is also associated with increased length of stay and mortality. Tests designed to assess for upper airway obstruction, secretion volume, and the effectiveness of cough seem most promising for improving the decision to extubate. Mortality increases with delays in reintubation for patients failing extubation. Timely identification of patients at elevated risk of extubation failure followed by rapid re-establishment of ventilatory support can improve outcome.

show abstract

“…BRUTON [32] performed the measurement according to the operator's decision and then recorded only the highest value. CARUSO et al [33] did not describe the method employed, while EL-KHATIB et al [34] performed three tests and recorded the average. No uniformity exists in the measurement of maximal respiratory pressures in the intensive care setting and in particular in difficult-to-wean and consequently tracheotomised patients.…”

Section: Discussionmentioning

confidence: 99%

Maximal inspiratory and expiratory pressure measurement in tracheotomised patients

Vitacca

Paneroni

Bianchi

et al. 2006

European Respiratory Journal

View full text Add to dashboard Cite

The present study compared four different sites and conditions for the measurement of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in 38 spontaneous breathing tracheotomised patients. Of the patients, 28 had chronic obstructive pulmonary disease (COPD).The four different conditions were: 1) through a cuff inflated cannula (condition A); 2) through the mouth with a deflated cannula (condition B); 3) through the mouth with a phonetic uncuffed cannula (condition C); and 4) through the mouth after stoma closure (condition D). Five trials in each condition were performed using a standardised method.The measurement of both MIP and MEP differed significantly depending on the condition of measurement. MIP taken in condition A was significantly higher when compared with conditions B, C and D. MEP in condition A was significantly higher when compared with condition B and D. In condition A the highest frequency of the best measurement of MIP and MEP was observed at the fourth and fifth effort, respectively. The same results were obtained after the selection of only COPD patients.In conclusion, respiratory muscle assessment differs significantly depending on measurement condition. Measurement through inflated cannula tracheotomy yields higher values of both maximal inspiratory and maximal expiratory pressure.

show abstract

Inspiratory pressure/maximal inspiratory pressure: does it predict successful extubation in critically ill infants and children?

Abstract: The PI/PImax ratio cannot be used to predict extubation outcome in pediatric patients. Indices that predict extubation outcome in adults should not be extrapolated to infants and children before testing and validation.

Cited by 38 publications

References 12 publications

Weaning from mechanical ventilation in pediatric intensive care patients

Weaning from mechanical ventilation in pediatric intensive care patients

Decision to extubate

Maximal inspiratory and expiratory pressure measurement in tracheotomised patients

Contact Info

Product

Resources

About