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A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients

2001; Springer Science+Business Media; Volume: 27; Issue: 10 Linguagem: Inglês

10.1007/s001340101035

1432-1238

J. Farías, Alejandra Retta, Inmaculada Alía, F. Olazarri, Martin Dres, A. Golubicki, Daniel Allende, O. Maliarchuk, C. Peltzer, María Elena Ratto, R. Zalazar, M. Garea, Ernesto Alfaro‐Moreno,

Respiratory Support and Mechanisms

Objective: To compare the percentage of infants and children successfully extubated after a trial of breathing performed with either pressure support or T-piece. Design: Prospective and randomized study. Setting: Three medical-surgical pediatric intensive care units (PICUs). Patients: Two hundred fifty-seven consecutive infants and children who received mechanical ventilation for at least 48 h and were deemed ready to undergo a breathing trial by their primary physician. Interventions: Patients were randomly assigned to undergo a trial of breathing in one of two ways: pressure support of 10 cmH2O or T-piece. Bedside measurements of respiratory function were obtained immediately before discontinuation of mechanical ventilation and within the first 5 min of breathing through a T-piece. The primary physicians were unaware of those measurements, and the decision to extubate a patient at the end of the breathing trial was made by them. Measurements and main results: Of the 125 patients in the pressure support group, 99 (79.2%) completed the breathing trial and were extubated, but 15 of them (15.1%) required reintubation within 48 h. Of the 132 patients in the T-piece group, 102 (77.5%) completed the breathing trial and were extubated, but 13 of them (12.7%) required reintubation within 48 h. The percentage of patients who remained extubated for 48 h after the breathing trial did not differ in the pressure support and T-piece groups (67.2% versus 67.4%, p=0.97). Conclusions: In infants and children mechanically ventilated, successful extubation was achieved equally effectively after a first breathing trial performed with pressure support of 10 cmH2O or a T-piece.