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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 18, 2011
A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients
1Unidad de Cuidados Intensivos Pediátricos, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, 1425 Buenos Aires, Argentina. jufarias@intramed.net.ar
Insights
Successful extubation in infants and children was equally effective using either pressure support or T-piece breathing trials. This randomized study compared mechanical ventilation weaning methods in pediatric intensive care units.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Mechanical Ventilation Management
Background:
- Mechanical ventilation is a critical support for infants and children in pediatric intensive care units (PICUs).
- Assessing readiness for extubation through a breathing trial is a crucial step in the weaning process.
- Different methods for breathing trials exist, including pressure support and T-piece, with varying implications for successful extubation.
Purpose of the Study:
- To compare the efficacy of pressure support versus T-piece breathing trials in achieving successful extubation in pediatric patients.
- To determine if one method leads to a higher rate of successful extubation and lower reintubation rates within 48 hours.
Main Methods:
- A prospective, randomized study was conducted across three medical-surgical PICUs.
- Two hundred fifty-seven infants and children on mechanical ventilation for at least 48 hours were enrolled.
- Patients were randomized to either a pressure support (10 cmH2O) or T-piece breathing trial, with extubation decisions made by primary physicians unaware of respiratory function measurements.
Main Results:
- The success rate of completing the breathing trial and extubation was similar between groups (79.2% for pressure support vs. 77.5% for T-piece).
- Reintubation rates within 48 hours were also comparable (15.1% for pressure support vs. 12.7% for T-piece).
- The primary outcome, percentage of patients remaining extubated for 48 hours, showed no significant difference (67.2% vs. 67.4%, p=0.97).
Conclusions:
- Pressure support (10 cmH2O) and T-piece methods are equally effective for initial breathing trials in mechanically ventilated infants and children.
- Both methods demonstrate similar success rates for extubation and reintubation within 48 hours.
- The choice between pressure support and T-piece for breathing trials does not significantly impact successful extubation outcomes in this pediatric population.
Objective:
To compare the percentage of infants and children successfully extubated after a trial of breathing performed with either pressure support or T-piece.
Design:
Prospective and randomized study.
Setting:
Three medical-surgical pediatric intensive care units (PICUs).
Patients:
Two hundred fifty-seven consecutive infants and children who received mechanical ventilation for at least 48 h and were deemed ready to undergo a breathing trial by their primary physician.
Interventions:
Patients were randomly assigned to undergo a trial of breathing in one of two ways: pressure support of 10 cmH2O or T-piece. Bedside measurements of respiratory function were obtained immediately before discontinuation of mechanical ventilation and within the first 5 min of breathing through a T-piece. The primary physicians were unaware of those measurements, and the decision to extubate a patient at the end of the breathing trial was made by them.
Measurements And Main Results:
Of the 125 patients in the pressure support group, 99 (79.2%) completed the breathing trial and were extubated, but 15 of them (15.1%) required reintubation within 48 h. Of the 132 patients in the T-piece group, 102 (77.5%) completed the breathing trial and were extubated, but 13 of them (12.7%) required reintubation within 48 h. The percentage of patients who remained extubated for 48 h after the breathing trial did not differ in the pressure support and T-piece groups (67.2% versus 67.4%, p=0.97).
Conclusions:
In infants and children mechanically ventilated, successful extubation was achieved equally effectively after a first breathing trial performed with pressure support of 10 cmH2O or a T-piece.
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