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Does taking endurance into account improve the prediction of weaning outcome in mechanically ventilated children?
Odile Noizet1, Francis Leclerc, Ahmed Sadik
1Paediatric Intensive Care Unit, University Hospital of Lille, Rue Eugène Avinée, 59037 Lille Cedex, France. odilenoizet@voila.fr
Insights
This study explored combining mechanical ventilation weaning predictors with endurance indices in children. While the combined index showed modest value, clinical judgment and spontaneous breathing trials remain superior for predicting weaning success.
Area of Science:
- Pediatric Intensive Care
- Respiratory Medicine
- Critical Care Medicine
Background:
- Mechanical ventilation is crucial for critically ill children.
- Predicting successful weaning from mechanical ventilation is challenging.
- Existing predictors may not fully capture a child's ability to sustain spontaneous breathing.
Purpose of the Study:
- To evaluate if combining Task Force (TF) predictors with weaning endurance indices improves prediction of weaning success in children.
- To identify the best single and combined indices for predicting weaning outcome.
Main Methods:
- Prospective study of 54 children undergoing mechanical ventilation in a tertiary pediatric ICU.
- Calculated TF indices (e.g., ROP, Pimax) and weaning endurance indices (e.g., TTI1, TTI2).
- Used logistic regression to develop and assess a combined predictive model.
Main Results:
- The best single TF index was ROP; the best endurance index was TTI2.
- A combined index (0.6 x ROP - 0.1 x Pimax + 0.5 x TTI2) showed predictive value (P < 0.01).
- This integrated index had modest performance, with clinical judgment and spontaneous breathing trials remaining superior.
Conclusions:
- A combined index incorporating endurance offers modest value in predicting pediatric weaning success.
- This is the first study to report on the utility of endurance parameters for weaning prediction in children.
- Clinical judgment and spontaneous breathing trials are currently superior to the proposed combined index.
Introduction:
We conducted the present study to determine whether a combination of the mechanical ventilation weaning predictors proposed by the collective Task Force of the American College of Chest Physicians (TF) and weaning endurance indices enhance prediction of weaning success.
Method:
Conducted in a tertiary paediatric intensive care unit at a university hospital, this prospective study included 54 children receiving mechanical ventilation (> or = 6 hours) who underwent 57 episodes of weaning. We calculated the indices proposed by the TF (spontaneous respiratory rate, paediatric rapid shallow breathing, rapid shallow breathing occlusion pressure [ROP] and maximal inspiratory pressure during an occlusion test [Pimax]) and weaning endurance indices (pressure-time index, tension-time index obtained from P(0.1) [TTI1] and from airway pressure [TTI2]) during spontaneous breathing. Performances of each TF index and combinations of them were calculated, and the best single index and combination were identified. Weaning endurance parameters (TTI1 and TTI2) were calculated and the best index was determined using a logistic regression model. Regression coefficients were estimated using the maximum likelihood ratio (LR) method. Hosmer-Lemeshow test was used to estimate goodness-of-fit of the model. An equation was constructed to predict weaning success. Finally, we calculated the performances of combinations of best TF indices and best endurance index.
Results:
The best single TF index was ROP, the best TF combination was represented by the expression (0.66 x ROP) + (0.34 x Pimax), and the best endurance index was the TTI2, although their performance was poor. The best model resulting from the combination of these indices was defined by the following expression: (0.6 x ROP) - (0.1 x Pimax) + (0.5 x TTI2). This integrated index was a good weaning predictor (P < 0.01), with a LR+ of 6.4 and LR+/LR- ratio of 12.5. However, at a threshold value < 1.3 it was only predictive of weaning success (LR- = 0.5).
Conclusion:
The proposed combined index, incorporating endurance, was of modest value in predicting weaning outcome. This is the first report of the value of endurance parameters in predicting weaning success in children. Currently, clinical judgement associated with spontaneous breathing trials apparently remain superior.
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