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Inspiratory pressure/maximal inspiratory pressure: does it predict successful extubation in critically ill infants
M F el-Khatib1, B Baumeister, P G Smith
1Division of Pediatric Pharmacology & Critical Care, Rainbow Babies and Children's Hospital, Cleveland, OH 44106-6010, USA.
Insights
The negative inspiratory pressure to maximal negative inspiratory pressure ratio does not accurately predict extubation success in pediatric patients. This index, validated in adults, should not be applied to children without further testing.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
Background:
- Extubation readiness in pediatric patients requires reliable predictive indices.
- The negative inspiratory pressure (PI) to maximal negative inspiratory pressure (PImax) ratio is used in adults to predict extubation outcomes.
Purpose of the Study:
- To assess the accuracy of the PI/PImax ratio in predicting extubation success in intubated pediatric patients.
Main Methods:
- A prospective study was conducted in a pediatric intensive care unit.
- 50 stable, intubated pediatric patients ready for extubation were enrolled.
- The PI/PImax ratio was measured using a one-way valve and correlated with extubation outcomes.
Main Results:
- 78% of patients were successfully extubated; 22% failed.
- The mean PI/PImax ratio was not significantly different between extubation success (0.36 ± 0.14) and failure (0.45 ± 0.1) groups (P > 0.05).
- The adult-derived cut-off value of 0.3 for PI/PImax did not differentiate between success and failure in pediatric patients.
Conclusions:
- The PI/PImax ratio is not a reliable predictor of extubation outcome in pediatric populations.
- Predictive indices validated in adult patients should not be extrapolated to pediatric patients without prior testing and validation.
Objective:
To evaluate the accuracy of the initial negative inspiratory pressure (PI) to maximal negative inspiratory pressure (PImax) ratio in predicting extubation outcome for intubated infants and children.
Design:
A prospective study.
Setting:
Pediatric intensive care unit.
Patients:
A sample of 50 stable intubated pediatric patients who were judged clinically ready for extubation.
Methods:
Using a one-way valve, PI and PImax were measured in all patients, after which the < or = ratio PI/PImax was calculated and its accuracy in predicting extubation outcome evaluated.
Measurements And Results:
A total of 39 patients (78%) were successfully extubated and 11 patients (22%) were not. The mean PI/PImax ratio was not significantly different between extubation successes (0.36 +/- 0.14) and failures (0.45 +/- 0.1) (P > 0.05). The cut-off value of 0.3 for PI/PImax identified in adult patients did not discriminate between extubation success and failure in children. Furthermore, a discriminatory cut-off value other than 0.3 could not be identified for infants and children.
Conclusion:
The PI/PImax ratio cannot be used to predict extubation outcome in pediatric patients. Indices that predict extubation outcome in adults should not be extrapolated to infants and children before testing and validation.