title: Deadspace to tidal volume ratio predicts successful extubation in infants and children.
abstract: OBJECTIVE
  Using a modification of the Bohr equation, single-breath carbon dioxide capnography is a noninvasive technology for calculating physiologic dead space (V(D)/V(T)). The objective of this study was to identify a minimal V(D)/V(T) value for predicting successful extubation from mechanical ventilation in pediatric patients.
  
  
  METHODS
  Prospective, blinded, clinical study.
  
  
  METHODS
  Medical and surgical pediatric intensive care unit of a university hospital.
  
  
  METHODS
  Intubated children ranging in age from 1 wk to 18 yrs.
  
  
  METHODS
  None.
  
  
  RESULTS
  Forty-five patients were identified by the pediatric intensive care unit clinical team as meeting criteria for extubation. Thirty minutes before the planned extubation, each patient was begun on pressure support ventilation set to deliver an exhaled tidal volume of 6 mL/kg. After 20 mins on pressure support ventilation, an arterial blood gas was obtained, V(D)/V(T) was calculated, and the patient was extubated. Over the next 48 hrs, the clinical team managed the patient without knowledge of the preextubation V(D)/V(T) value. Of the 45 patients studied, 25 had V(D)/V(T) < or =0.50. Of these patients, 24 of 25 (96%) were successfully extubated without needing additional ventilatory support. In an intermediate group of patients with V(D)/V(T) between 0.50 and 0.65, six of ten patients (60%) successfully extubated from mechanical ventilation. However, only two of ten patients (20%) with a V(D)/V(T) > or =0.65 were successfully extubated. Logistic regression analysis revealed a significant association between lower V(D)/V(T) and successful extubation.
  
  
  CONCLUSIONS
  A V(D)/V(T) < or =0.50 reliably predicts successful extubation, whereas a V(D)/V(T) >0.65 identifies patients at risk for respiratory failure following extubation. There appears to be an intermediate V(D)/V(T) range (0.51-0.65) that is less predictive of successful extubation. Routine V(D)/V(T) monitoring of pediatric patients may permit earlier extubation and reduce unexpected extubation failures.
authors.affiliation: Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Hubble
authors.forename: M A
authors.initials: MA
authors.lastname: Gentile
authors.forename: D S
authors.initials: DS
authors.lastname: Tripp
authors.forename: D M
authors.initials: DM
authors.lastname: Craig
authors.forename: J N
authors.initials: JN
authors.lastname: Meliones
authors.forename: I M
authors.initials: IM
authors.lastname: Cheifetz
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007440:Intubation; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012126:Respiratory Dead Space; D013990:Tidal Volume; D015300:Ventilator Weaning