Weaning from mechanical ventilation  in pediatric intensive care patients

Farias, Júlio A.; Alía, Inmaculada; Esteban, Andrés; Golubicki, A; Olazarri, F

doi:10.1007/s001340050718

Cited by 83 publications

(67 citation statements)

References 21 publications

(23 reference statements)

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“…Using 5 cm H 2 O CPAP rather than no pressure support during the measurements may have affected the performance of the RSB index (26) as values are higher during unassisted breathing than with pressure support (26). In children, however, when RSB was assessed without pressure support, the area under the ROC curve was only 0.57 (9). The broad age range and hence respiratory rates encountered in the pediatric population may make the RSB index inappropriate as a predictor of extubation outcome in that setting (8).…”

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.…”

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confidence: 86%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 86%

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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“…It is suggested that nurses and allied health professionals tend to adhere to protocols more readily as a result of their different training and professional cultures (Lawton and Parker, 1999) and, indeed, the majority of studies evaluating the efficacy of weaning protocols have focused on comparing nurse or respiratory therapist (RT) led weaning using protocols with traditional doctor-led practice. The evidence is fairly evenly divided in both the adult and paediatric literature: some studies demonstrated more effective patient outcomes with protocolisedweaning (Ely et al, 1996;Farias et al, 1998;Grap et al, 2003;Horst et al, 1998;Kollef et al, 1997;Scheinhorn et al, 2001) and a similar number demonstrated no significant difference in outcomes Burns et al, 1998;Djunaedi et al, 1997;Keogh et al, 2003;Krishnan et al, 2004;Randolph et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

The impact of nurse-directed protocolised-weaning from mechanical ventilation on nursing practice: A quasi-experimental study

Blackwood¹,

Wilson‐Barnett

2007

International Journal of Nursing Studies

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“…6 Bousso et al remark that the difference in results could be reflecting the presence of populations with dissimilar characteristics. This is a common situation when analyzing studies conducted in South America, where there is a predominance of primary respiratory diseases 1,5,[8][9][10]14 compared to the United States or Europe, with predominance of elective surgical patients. 4,6,11,15 At this time, there still are no reliable criteria to predict which patients will require reintubation after tolerating a spontaneous breathing trial.…”

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confidence: 99%