PREDICTION OF WEANING FAILURE OF MECHANICAL VENTILATION USING CLINICAL PARAMETERS IN PICU

Abstract

ABSTRACT
Background:Mechanical ventilation is a life support intervention that is used for a large number of
patients in Pediatric intensive care units. The current pediatric literature shows that the science of
ventilator weaning and extubation remains undetermined. No optimal weaning method has been
described for a more rapid and successful extubation.
Objective:Weaning predictors are used as a decision point in protocols to determine whether a
patient may advance to a spontaneous breathing trial. We designed a study to determine the effect
of including a weaning predictor (clinical weaning parameters) in a weaning protocol.
Subjects & Methods:
 Cross section study was conducted on 53 children who admitted to PICU. All patients
should be eligible for weaning from mechanical ventilation. Clinical data and laboratory
investigations were obtained on admission. Patients underwent a spontaneous breathing trial (SBT)
after reversal of the underlying cause for respiratory failure and when they met all the weaning
criteria. Then Rapid shallow breathing index (RSBI) was performed. As RSBI ≤ 8
breath/min/ml/kg, PaO2 > 60 mmHg, Pa CO2 < 50 mmHg, FiO2 < 0.5, PaO2/FiO2 > 200 mg, Tidal
volume (VT) > 5 ml/kg, Ve >200 ml/min/kg, PEEP < 5 CmH2O and RR < 45 breath/min.
 Weaning failure is defined as the inability to sustain spontaneous breathing without any
form of ventilator support, for at least 48 h. The results were tabulated and analyzed with SPSS.
Results:RSBI differed significantly between patients who succeeded weaning from mechanical
ventilation and those who failed (3.12±1 vs. 9.5±1.04 breath/min/ml/kg; P < 0.001). A cutoff value
≥3.5 breath/min/ml/kg on were associated with a prediction of failure of weaning from mechanical
ventilation with a 100%sensitivity, 75% specificity,0.724 positive predictive value (PPV), 1
negative predictive value (NPV) and 84.91% accuracy.
Conclusion and key messages:Clinical weaning parameter could be considered a sensitive and
specific marker for prediction of weaning failure.
Keywords
Weaning; extubation; mechanical ventilation; pediatric Intensive Care Unit; weaning criteria;
spontaneous breathing.