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Differences in respiratory parameters during continuous positive airway pressure and pressure support ventilation in
1Department of Intensive Care Medicine, Tohoku University School of Medicine, Sendai, Japan. k-hoshi@anes.med.tohoku.ac.jp
Insights
Extubation criteria for infants and children remain unclear. This study found no significant differences in respiratory parameters between continuous positive airway pressure (CPAP) and pressure support ventilation (PSV) before extubation, suggesting existing CPAP criteria may apply.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
Background:
- Established extubation criteria for infants and children on pressure support ventilation (PSV) are lacking.
- Continuous positive airway pressure (CPAP) is commonly used for weaning, but its comparison with PSV regarding extubation readiness is not well-defined.
Purpose of the Study:
- To compare respiratory parameters between CPAP and PSV in children ready for extubation.
- To determine if existing extubation criteria for CPAP can be applied to PSV.
Main Methods:
- Nineteen pediatric patients nearing extubation were studied.
- Respiratory parameters including tidal volume (TV), respiratory frequency (RR), duty ratio (DR), and mean inspiratory flow (MF) were measured under both CPAP (3 cmH2O) and PSV (3 cmH2O with 3 cmH2O PEEP) modes.
- The sequence of ventilatory modes was randomized, and all patients were successfully extubated without reintubation.
Main Results:
- No significant differences were observed in TV, RR, DR, or MF between CPAP and PSV modes.
- Tidal volume was 61.6±54.9 ml on CPAP and 67.7±61.4 ml on PSV.
- Respiratory rate was 38.5±10.6 beats/min on CPAP and 37.1±8.8 beats/min on PSV.
- Duty ratio was 0.382±0.067 on CPAP and 0.359±0.085 on PSV.
- Mean inspiratory flow was 96.6±78.3 ml/sec on CPAP and 101.0±69.0 ml/sec on PSV.
Conclusions:
- Respiratory parameters are similar between CPAP and PSV in children ready for extubation.
- Existing extubation criteria used for CPAP can likely be applied to PSV in pediatric patients.
- This finding supports the use of current CPAP-based extubation guidelines for PSV, simplifying weaning protocols.
Abstract:
The extubation criteria of pressure support ventilation (PSV) in infants and children were not yet established. We studied the differences in respiratory parameters during continuous positive airway pressure (CPAP) using a constant flow type ventilator and PSV using a demand valve type ventilator. Nineteen children (1.9+/-2.9 years old) who were ready to extubate were studied. All patients had recovered from their respiratory failure and had finished the weaning process of the ventilatory support. They were scheduled for extubation on the next day when their ventilatory mode had attained to a PSV of 3 cmH2O with a positive end-expiratory pressure (PEEP) of 3 cmH2O. On the extubation day, tidal volume (TV) and respiratory frequency (RR) were measured with a respiratory monitor at two modes (CPAP of 3 cmH2O and PSV), and the duty ratio (DR) and mean inspiratory flow (MF) were calculated. The sequence of the ventilatory mode was random. No case required reintubation. TV was 61.6+/-54.9 during CPAP and 67.7+/-61.4 ml during PSV, and RR was 38.5+/-10.6 and 37.1+/-8.8 beats/min., respectively. DR was 0.382+/-0.067 and 0.359+/-0.085, and MF was 96.6+/-78.3 and 101.0+/-69.0 ml/sec., respectively. The measured parameters and calculated values showed no significant difference between CPAP and PSV. It was found that the respiratory parameters were almost the same with CPAP and PSV immediately before the extubation, and the previous extubation criteria of CPAP can be used.