Evaluation of a Mapleson D CPAP system for weaning of mechanical ventilation in pediatric patients.
Over the last years, we have used a flow-inflating bag circuit with a nasotracheal or nasopharyngeal tube as an interface to deliver effective CPAP support in infants ("Mapleson D CPAP system"). The primary goal of this study was to assess the usefulness of the "Mapleson D CPAP system" for weaning of mechanical ventilation (MV) in infants who received MV over 24 h.



All infants who received MV for more than 24 h in the last year were enrolled in the study. Demographic data included age, gender, weight, and admission diagnosis. Heart rate, respiratory rate, blood pressure, and oxygen saturation were measured during MV, 2 h after the nasotracheal Mapleson D CPAP system and 2 h after extubation. Patients were classified into two groups: patients MV more than 48 h, and patients with MV fewer than 48 h. P < 0.05 was considered statistically significant.



A total of 50 children were enrolled in the study, with a median age was 34 ± 45 months (range, 1-59 months) and median weight was 11.98 ± 9.31 kg (range, 1-48 kg). Median duration of MV was 480 h (range, 2-570). There were no significant differences in PaO2, PaCO2, and pH among MV, 2 h after the nasotracheal Mapleson D CPAP system and 2 h after extubation and spontaneous ventilation with the nasopharyngeal Mapleson D CPAP system or with nasal prongs. The overall extubation failure rate was 26% (n = 13). Weight and age were significantly associated with extubation failure (P < 0.05).



The Mapleson D CPAP system, in our opinion, is a useful and safe alternative to more complex and expensive noninvasive CPAP and BiPAP weaning from MV in infants.
Department of Anesthesiology, Salamanca University Hospital, Salamanca, Spain.
Miguel Angel
MA
Palomero-Rodríguez
Department of Medical, Merck, Mostoles University Hospital, Mostoles, Spain.
Héctor Chozas
HC
de Arteaga
Department of Anesthesiology, Mostoles University Hospital, Mostoles, Spain.
Yolanda Laporta
YL
Báez
Department of Anesthesiology, La Paz University Hospital, Madrid, Spain.
Jesús
J
de Vicente Sánchez
Department of Anesthesiology, La Paz University Hospital, Madrid, Spain.
Pascual Sanabria
PS
Carretero
Department of Medical, Merck, Mostoles University Hospital, Mostoles, Spain.
Pilar Sánchez
PS
Conde
Department of Anesthesiology, La Paz University Hospital, Madrid, Spain.
Antonio
A
Pérez Ferrer
CPAP; nasopharyngeal tube; noninvasive ventilation; prolonged ventilation; weaning