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Prediction of prolonged ventilator dependence in children by respiratory function measurements
A Greenough1, S Naik, M Kinali
1Department of Child Health, King's College Hospital, London, UK. anne.greenough@kcl.ac.uk
Insights
Early respiratory function measurements can predict prolonged ventilator dependence in children. Lower respiratory system compliance on day one identified children needing extended ventilatory support, aiding early intervention strategies.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
Background:
- Prolonged mechanical ventilation increases complication risks in children.
- Predicting ventilatory dependence is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To assess if early respiratory function measurements predict prolonged ventilatory dependence in children.
- To compare the predictive accuracy of respiratory function tests versus clinical data.
Main Methods:
- Retrospective analysis of 33 children on constant flow ventilation.
- Measurement of respiratory system compliance (CRS) and resistance (RRS) on day one of support.
- Logistic regression to identify predictors of prolonged ventilatory dependence (> or = 4 days).
Main Results:
- Lower CRS on day one was significantly associated with prolonged ventilatory dependence (p < 0.01).
- Higher peak inspiratory pressure (PIP) and oxygen requirements also correlated with dependence.
- Low CRS (<0.4 ml/cmH2O kg⁻¹) and high maximum PIP (>27 cmH2O) showed similar predictive accuracy (83% sensitivity).
Conclusions:
- Early measurement of respiratory system compliance is a valuable tool for identifying children at risk of prolonged ventilator dependence.
- These findings support the use of respiratory function tests to guide preventative strategies in pediatric mechanical ventilation.
Abstract:
Complications of ventilatory support are more common if this assistance is prolonged. Our aim was to determine if results of respiratory function measurement on the first day of ventilation identified children who would develop prolonged ventilatory dependence (> or = 4 days) and whether such results were a more accurate predictor than readily available clinical data. Thirty three children, median age 2 years (range 0.1-13.6), who were supported by a constant flow ventilator and hence had measurements of compliance of the respiratory system (CRS) and resistance of the respiratory system (RRS) on the first day of ventilatory support, were retrospectively identified. Those who needed prolonged ventilatory support had a lower CRS on day one (p < 0.01) and required at any time during their ventilatory career both a higher maximum inspired oxygen concentration (p < 0.01) and peak inspiratory pressure (PIP) (p < 0.01). Logistic regression analysis demonstrated that only a low CRS and high maximum PIP were significantly correlated with prolonged ventilator dependence. A low CRS (<0.4 (ml/cmH2O) kg(-1)) and a high maximum PIP (>27 cmH2O) had similar sensitivities (83%) and specificities (71% and 67% respectively) in predicting prolonged ventilatory dependence. The CRS results, unlike the maximum PIP results, however, were always available on the first day of ventilatory support. We therefore conclude that respiratory function measurements have a role in identifying children who would benefit from strategies to prevent prolonged ventilator dependence.