The objective of the research was to establish the impact of diaphragm-protective mechanical ventilation on the rate of successful weaning from invasive and non-invasive mechanical ventilation in children with acute respiratory failure.
Materials and Methods. We conducted a prospective, observational cohort study. Seventy-eight patients were randomly divided into 2 groups: patients of Group I received lung-protective mechanical ventilation; patients of Group II received diaphragm-protective + lung-protective mechanical ventilation. For age-specific data analysis, patients were divided into age subgroups: the 1st subgroup included children being 1 to 12 months old; the 2nd age subgroup comprised children being 12 to 36 months old. We started respiratory support in both groups with invasive mechanical ventilation and when patients met the criteria, we weaned them. We confirmed successful weaning, when patients had no need to be mechanically ventilated within next 48 hours, otherwise, they were intubated again. Before the second trial to wean, patients in Group I were simply extubated, while patients in Group II received non-invasive mechanical ventilation. The primary endpoint was the rate of successful weaning from mechanical ventilation in the first trial. The secondary outcomes were complications, namely reintubation rate, tracheostomy rate and death.
Results. We found a significant difference in the primary outcome for the 1st age subgroup: there were 72.4% in Group I vs. 52.6% in Group II successfully weaned patients (p=0.04). No significant difference in the primary outcome was observed in the 2nd age subgroup: there were 80% in Group I vs. 82.3% in Group II successfully weaned patients (p=0.78). There were significant differences in the secondary outcomes between groups in the 1st age subgroup, namely reintubation rate was seen in 9.1% patients of Group I vs. 36.8% patients of Group II (p=0.05); death happened in 18.2% cases in Group I vs. no cases in Group II (p=0.01). There were no differences in tracheostomy rate in the 1st age subgroup and there were no differences in the secondary outcomes between groups in 2nd age subgroup.
Conclusions. Diaphragm-protective mechanical ventilation significantly reduced the incidence of successful weaning from invasive mechanical ventilation; however, it increased the incidence of successful weaning from non-invasive mechanical ventilation, and, significantly decreased the mortality rate in the 1st age subgroup, while in the 2nd age subgroup, it had no impact on the incidence of successful weaning from invasive mechanical ventilation and mortality rate.
Fedor KL. Noninvasive Respiratory Support in Infants and Children. Respir Care [Internet]. 2017 Jun 25; 62(6):699-717. DOI: https://doi.org/10.4187/respcare.05244 [PMid:28546373]
Hawkins SMM, Jensen EL, Simon SL, Friedman NR. Correlates of Pediatric CPAP Adherence. J Clin Sleep Med [Internet]. 2016 Jun 15; 12(06):879-84. DOI: https://doi.org/10.5664/jcsm.5892 [PMid:27092702 PMCid:PMC4877321]
Nascimento MS, Rebello CM, Vale LAPA, Santos É , Prado C do. Spontaneous breathing test in the prediction of extubation failure in the pediatric population. Einstein(Sã o Paulo) [Internet]. 2017 Jun 15; 15(2):162-6. DOI: https://doi.org/10.1590/s1679-45082017ao3913 [PMid:28767913 PMCid:PMC5609611]
Bonora JP, Frydman J, Retta A, Canepari A. Post-extubation non-invasive ventilation in the pediatric intensive care unit: a multicenter study. Arch Argent Pediatr. 2018; 116(5):333-339. DOI: https://doi.org/10.5546/aap.2018.eng.333
Harikumar G, Egberongbe Y, Nadel S, Wheatley E, Moxham J, Greenough A, et al. Tension-Time Index as a Predictor of Extubation Outcome in Ventilated Children. Am J Respir Crit Care Med [Internet]. 2009 Nov 15; 180(10):982-8. DOI: https://doi.org/10.1164/rccm.200811-1725OC [PMid:19696443 PMCid:PMC2778157]
Yaman A, Kendirli T, Ö dek Ç , Ateş C, Taşyapar N, Gü neş M, et al. Efficacy of noninvasive mechanical ventilation in prevention of intubation and reintubation in the pediatric intensive care unit. J Crit Care [Internet]. 2016 Apr 15; 32(10):175-81. DOI: https://doi.org/10.1016/j.jcrc.2015.12.013 [PMid:26795440]
Haut C. Pediatric Noninvasive Ventilation. J Pediatr Intensive Care [Internet]. 2015 Aug 28; 04(02):121-7. DOI: https://doi.org/10.1055/s-0035-1556754 [PMid:31110861 PMCid:PMC6513139]
S. Rolim D, Galas FRB, Faria LS, Amorim EF, Regenga MM, Troster EJ. Use of Noninvasive Ventilation in Respiratory Failure After Extubation During Postoperative Care in Pediatrics. Pediatr Cardiol [Internet]. 2020 Apr 5; 41(4):729-35. DOI: https://doi.org/10.1007/s00246-020-02290-6 [PMid:32025758 PMCid:PMC7223835]
Bandyopadhyay A, Cristea AI, Davis SD, Ackerman VL, Slaven JE, Jalou HE, et al. Retrospective Analysis of Factors Leading to Pediatric Tracheostomy Decannulation Failure. A Single-Institution Experience. Ann Am Thorac Soc [Internet]. 2017 Jan 5; 14(1):70-5. DOI: https://doi.org/10.1513/AnnalsATS.201607-553OC [PMid:27768853 PMCid:PMC5461993]
dos Santos Bacci SLL, Johnston C, Hattori WT, Pereira JM, de Oliveira Azevedo VMG. Mechanical ventilation weaning practices in neonatal and pediatric ICUs in Brazil: the Weaning Survey-Brazil. J Bras Pneumol [Internet]. 2020 Jan 5; 46(1):e20190005-e20190005. DOI: https://doi.org/10.36416/1806-3756/e20190005 [PMid:32215452]
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