A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients.
OBJECTIVE
To compare the percentage of infants and children successfully extubated after a trial of breathing performed with either pressure support or T-piece.


METHODS
Prospective and randomized study.


METHODS
Three medical-surgical pediatric intensive care units (PICUs).


METHODS
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.


METHODS
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.


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.
Farias
J A
JA
Unidad de Cuidados Intensivos Pediátricos, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, 1425 Buenos Aires, Argentina. jufarias@intramed.net.ar
Retta
A
A
Alía
I
I
Olazarri
F
F
Esteban
A
A
Golubicki
A
A
Allende
D
D
Maliarchuk
O
O
Peltzer
C
C
Ratto
M E
ME
Zalazar
R
R
Garea
M
M
Moreno
E G
EG
D000367:Age Factors; D001784:Blood Gas Analysis; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008171:Lung Diseases / Q000209:etiology / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012720:Severity of Illness Index; D013990:Tidal Volume; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000295:instrumentation / Q000379:methods*