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

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Last updated: 01 Jan 2025

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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.

DOI

10.21608/zumj.2018.13261

Keywords

Weaning, Extubation, Mechanical Ventilation, pediatric intensive care unit, weaning criteria, spontaneous breathing

Authors

First Name

Rabab

Last Name

El-Beheidy

MiddleName

Mohamed

Affiliation

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Orcid

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First Name

Dalia

Last Name

Abdulrahman

MiddleName

Abdullatif

Affiliation

-

Email

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City

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Orcid

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First Name

Sameh

Last Name

Bayoumi

MiddleName

Saber

Affiliation

-

Email

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City

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Orcid

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First Name

Walaa

Last Name

Hassan

MiddleName

Abdul Hakim

Affiliation

-

Email

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Volume

24

Article Issue

5

Related Issue

2570

Issue Date

2018-09-01

Receive Date

2018-09-10

Publish Date

2018-09-01

Page Start

386

Page End

393

Print ISSN

1110-1431

Online ISSN

2357-0717

Link

https://zumj.journals.ekb.eg/article_13261.html

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https://zumj.journals.ekb.eg/service?article_code=13261

Order

4

Type

Original Article

Type Code

273

Publication Type

Journal

Publication Title

Zagazig University Medical Journal

Publication Link

https://zumj.journals.ekb.eg/

MainTitle

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

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Article

Created At

22 Jan 2023