title: Tension-time index as a predictor of extubation outcome in ventilated children.
abstract: BACKGROUND
  Indices that assess the load on the respiratory muscles, such as the tension-time index (TTI), may predict extubation outcome.
  
  
  OBJECTIVE
  To evaluate the performance of a noninvasive assessment of TTI, the respiratory muscle tension time index (TTmus), by comparison to that of the diaphragm tension time index (TTdi) and other predictors of extubation outcome in ventilated children.
  
  
  METHODS
  Eighty children (median [range] age 2.1 yr [0.15-16]) admitted to pediatric intensive care units at King's College and St Mary's Hospitals who required mechanical ventilation for more than 24 hours were studied.
  
  
  RESULTS
  TTmus, maximal inspiratory pressure, respiratory drive, respiratory system mechanics, and functional residual capacity using a helium dilution technique, the rapid shallow breathing and CROP indices (compliance, rate, oxygenation, and pressure) indexed for body weight were measured and standard clinical data recorded in all patients. TTdi was measured in 28 of the 80 children using balloon catheters. Eight children (three in the TTdi group) failed extubation. TTmus (0.199 vs. 0.09) and TTdi (0.157 vs. 0.07) were significantly higher in children who failed extubation. TTmus greater than 0.18 (n = 80) and TTdi greater than 0.15 (n = 28) had sensitivities and specificities of 100% in predicting extubation failure. The other predictors performed less well.
  
  
  CONCLUSIONS
  Invasive and noninvasive measurements of TTI may provide accurate prediction of extubation outcome in mechanically ventilated children.
authors.affiliation: Department of Child Health, 4th Floor Golden Jubilee Wing, King's College London School of Medicine, Bessemer Road, London SE5 9PJ, UK.
authors.forename: Gopinathannair
authors.initials: G
authors.lastname: Harikumar
authors.forename: Yaya
authors.initials: Y
authors.lastname: Egberongbe
authors.forename: Simon
authors.initials: S
authors.lastname: Nadel
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wheatley
authors.forename: John
authors.initials: J
authors.lastname: Moxham
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
authors.forename: Gerrard F
authors.initials: GF
authors.lastname: Rafferty
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D003964:Diaphragm / Q000502:physiology; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D012121:Respiration, Artificial; D012132:Respiratory Muscles / Q000502:physiology*; D016896:Treatment Outcome; D015300:Ventilator Weaning
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