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Evaluation of predictors of weaning from mechanical ventilation in pediatric patients
B L Baumeister1, M el-Khatib, P G Smith
1Division of Pediatric Pharmacology and Critical Care, Rainbow Babies and Childrens Hospital, Cleveland, Ohio 44106-6010, USA.
Insights
New breathing indices predict successful extubation in children. The modified CROP index demonstrated superior accuracy compared to the Rapid Shallow Breathing (RSB) index in pediatric patients requiring mechanical ventilation.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Mechanical ventilation
Background:
- Objective criteria for weaning pediatric patients from mechanical ventilation are lacking.
- Existing extubation prediction indices (RSB and CROP) were developed for adults.
Purpose of the Study:
- To evaluate the applicability of adapted Rapid Shallow Breathing (RSB) and CROP indices in predicting extubation success in pediatric patients.
- To determine reliable cutoff values for these indices in the pediatric population.
Main Methods:
- Adapted RSB and CROP indices were applied to 47 intubated, mechanically ventilated pediatric patients.
- Measurements included spontaneous tidal volume, respiratory rate, and dynamic compliance using a pneumotachograph.
- Tidal volume and dynamic compliance were adjusted for patient body weight.
Main Results:
- The modified CROP index cutoff of >= 0.1 ml x mmHg/bpm/kg predicted successful extubation with 100% sensitivity and specificity.
- The modified RSB index cutoff of <= 11 bpm/mlkg showed 79% sensitivity and 78% specificity.
- 81% of patient data sets (38/47) were from successful extubations.
Conclusions:
- Adapted CROP and RSB indices are predictive of successful extubation in pediatric patients.
- The modified CROP index is a superior tool for discriminating between successful and failed extubation in this population.
Abstract:
Objective criteria for ending mechanical ventilation have not been established for infants and children. A recent study in adult patients developed two new indexes, the Rapid Shallow Breathing Index (RSB) and the CROP Index for predicting success or failure of extubation. We decided to evaluate the applicability of these indices to intubated, mechanically ventilated pediatric patients. For this evaluation the indices were adapted to the physiology of infants and children. A pneumotachograph was used to measure spontaneous tidal volume, respiratory rate and dynamic compliance. The tidal volume and the dynamic compliance were corrected for the patient's body weight. Based on the data collected a cutoff value for each index was determined. Of 47 sets of patient data, 38 (81%) were collected during successful extubations, 9 (19%) during failed extubations. A modified CROP index value of > or = 0.1 ml x mmHg/bpm/kg and a modified RSB index value of < or = 11 bpm/mlkg were identified as predictive of successful extubation. The modified CROP cutoff value produced a sensitivity and specificity of 1.0; respective values for the modified RSB cutoff value are 0.79 and 0.78. Cutoff values of > or = 0.1 and < or = 11 for the modified CROP index and RSB index, respectively, appear to be predictive of successful extubation in the pediatric population. Our data identifies the modified CROP index as a superior discriminator between successful and unsuccessful extubation.