| Title |
Pediatric extubation readiness tests should not use pressure support
|
|---|---|
| Published in |
Intensive Care Medicine, June 2016
|
| DOI | 10.1007/s00134-016-4387-3 |
| Pubmed ID | |
| Authors |
Robinder G. Khemani, Justin Hotz, Rica Morzov, Rutger C. Flink, Asvari Kamerkar, Marie LaFortune, Gerrard F. Rafferty, Patrick A. Ross, Christopher J. L. Newth |
| Abstract |
Pressure support is often used for extubation readiness testing, to overcome perceived imposed work of breathing from endotracheal tubes. We sought to determine whether effort of breathing on continuous positive airway pressure (CPAP) of 5 cmH2O is higher than post-extubation effort, and if this is confounded by endotracheal tube size or post-extubation noninvasive respiratory support. Prospective trial in intubated children. Using esophageal manometry we compared effort of breathing with pressure rate product under four conditions: pressure support 10/5 cmH2O, CPAP 5 cmH2O (CPAP), and spontaneous breathing 5 and 60 min post-extubation. Subgroup analysis excluded post-extubation upper airway obstruction (UAO) and stratified by endotracheal tube size and post-extubation noninvasive respiratory support. We included 409 children. Pressure rate product on pressure support [100 (IQR 60, 175)] was lower than CPAP [200 (120, 300)], which was lower than 5 min [300 (150, 500)] and 60 min [255 (175, 400)] post-extubation (all p < 0.01). Excluding 107 patients with post-extubation UAO (where pressure rate product after extubation is expected to be higher), pressure support still underestimated post-extubation effort by 126-147 %, and CPAP underestimated post-extubation effort by 17-25 %. For all endotracheal tube subgroups, ≤3.5 mmID (n = 152), 4-4.5 mmID (n = 102), and ≥5.0 mmID (n = 48), pressure rate product on pressure support was lower than CPAP and post-extubation (all p < 0.0001), while CPAP pressure rate product was not different from post-extubation (all p < 0.05). These findings were similar for patients extubated to noninvasive respiratory support, where pressure rate product on pressure support before extubation was significantly lower than pressure rate product post-extubation on noninvasive respiratory support (p < 0.0001, n = 81). Regardless of endotracheal tube size, pressure support during extubation readiness tests significantly underestimates post-extubation effort of breathing. |
X Demographics
The data shown below were collected from the profiles of 24 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 9 | 38% |
| Germany | 1 | 4% |
| Spain | 1 | 4% |
| United Arab Emirates | 1 | 4% |
| South Africa | 1 | 4% |
| Kenya | 1 | 4% |
| Malaysia | 1 | 4% |
| Uruguay | 1 | 4% |
| Unknown | 8 | 33% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 12 | 50% |
| Practitioners (doctors, other healthcare professionals) | 7 | 29% |
| Scientists | 5 | 21% |
Mendeley readers
The data shown below were compiled from readership statistics for 157 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 157 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 26 | 17% |
| Student > Postgraduate | 18 | 11% |
| Researcher | 17 | 11% |
| Student > Master | 14 | 9% |
| Student > Bachelor | 11 | 7% |
| Other | 29 | 18% |
| Unknown | 42 | 27% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 84 | 54% |
| Nursing and Health Professions | 18 | 11% |
| Agricultural and Biological Sciences | 5 | 3% |
| Engineering | 4 | 3% |
| Biochemistry, Genetics and Molecular Biology | 2 | 1% |
| Other | 3 | 2% |
| Unknown | 41 | 26% |
Attention Score in Context
This research output has an Altmetric Attention Score of 16. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 07 November 2022.
All research outputs
#2,318,831
of 25,729,842 outputs
Outputs from Intensive Care Medicine
#1,787
of 5,479 outputs
Outputs of similar age
#40,903
of 370,742 outputs
Outputs of similar age from Intensive Care Medicine
#5
of 44 outputs
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