The effect of pressure support on imposed work of breathing during paediatric extubation readiness testing
Abstract Background Paediatric critical care practitioners often make use of pressure support (PS) to overcome the perceived imposed work of breathing (WOBimp) during an extubation readiness test (ERT). However, no paediatric data are available that shows the necessity of adding of pressure support...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2019-07-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-019-0549-0 |
| _version_ | 1828825464712462336 |
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| author | Jefta van Dijk Robert G. T. Blokpoel Alette A. Koopman Sandra Dijkstra Johannes G. M. Burgerhof Martin C. J. Kneyber |
| author_facet | Jefta van Dijk Robert G. T. Blokpoel Alette A. Koopman Sandra Dijkstra Johannes G. M. Burgerhof Martin C. J. Kneyber |
| author_sort | Jefta van Dijk |
| collection | DOAJ |
| description | Abstract Background Paediatric critical care practitioners often make use of pressure support (PS) to overcome the perceived imposed work of breathing (WOBimp) during an extubation readiness test (ERT). However, no paediatric data are available that shows the necessity of adding of pressure support during such tests. We sought to measure the WOBimp during an ERT with and without added pressure support and to study its clinical correlate. This was a prospective study in spontaneously breathing ventilated children < 18 years undergoing ERT. Using tracheal manometry, WOBimp was calculated by integrating the difference between positive end-expiratory pressure (PEEP) and tracheal pressure (Ptrach) over the measured expiratory tidal volume (VTe) under two paired conditions: continuous positive airway pressure (CPAP) with and without PS. Patients with post-extubation upper airway obstruction were excluded. Results A total of 112 patients were studied. Median PS during the ERT was 10 cmH2O. WOBimp was significantly higher without PS (median 0.27, IQR 0.20–0.50 J/L) than with added PS (median 0.00, IQR 0.00–0.11 J/L). Although there were statistically significant changes in spontaneous breath rate [32 (23–42) vs. 37 (27–46) breaths/min, p < 0.001] and higher ET-CO2 [5.90 (5.38–6.65) vs. 6.23 (5.55–6.94) kPa, p < 0.001] and expiratory Vt decreased [7.72 (6.66–8.97) vs. 7.08 (5.82–8.08) mL/kg, p < 0.001] in the absence of PS, these changes appeared clinically irrelevant since the Comfort B score remained unaffected [12 (10–13) vs. 12 (10–13), P = 0.987]. Multivariable analysis showed that changes in WOBimp occurred independent of endotracheal tube size. Conclusions Withholding PS during ERT does not lead to clinically relevant increases in WOBimp, irrespective of endotracheal tube size. |
| first_indexed | 2024-12-12T14:17:44Z |
| format | Article |
| id | doaj.art-56c8816cf11142fabb75d3507a3226c7 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-12T14:17:44Z |
| publishDate | 2019-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-56c8816cf11142fabb75d3507a3226c72022-12-22T00:21:52ZengSpringerOpenAnnals of Intensive Care2110-58202019-07-01911710.1186/s13613-019-0549-0The effect of pressure support on imposed work of breathing during paediatric extubation readiness testingJefta van Dijk0Robert G. T. Blokpoel1Alette A. Koopman2Sandra Dijkstra3Johannes G. M. Burgerhof4Martin C. J. Kneyber5Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of GroningenDivision of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of GroningenDivision of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of GroningenDivision of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of GroningenDepartment of Epidemiology, University Medical Center Groningen, University of GroningenDivision of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of GroningenAbstract Background Paediatric critical care practitioners often make use of pressure support (PS) to overcome the perceived imposed work of breathing (WOBimp) during an extubation readiness test (ERT). However, no paediatric data are available that shows the necessity of adding of pressure support during such tests. We sought to measure the WOBimp during an ERT with and without added pressure support and to study its clinical correlate. This was a prospective study in spontaneously breathing ventilated children < 18 years undergoing ERT. Using tracheal manometry, WOBimp was calculated by integrating the difference between positive end-expiratory pressure (PEEP) and tracheal pressure (Ptrach) over the measured expiratory tidal volume (VTe) under two paired conditions: continuous positive airway pressure (CPAP) with and without PS. Patients with post-extubation upper airway obstruction were excluded. Results A total of 112 patients were studied. Median PS during the ERT was 10 cmH2O. WOBimp was significantly higher without PS (median 0.27, IQR 0.20–0.50 J/L) than with added PS (median 0.00, IQR 0.00–0.11 J/L). Although there were statistically significant changes in spontaneous breath rate [32 (23–42) vs. 37 (27–46) breaths/min, p < 0.001] and higher ET-CO2 [5.90 (5.38–6.65) vs. 6.23 (5.55–6.94) kPa, p < 0.001] and expiratory Vt decreased [7.72 (6.66–8.97) vs. 7.08 (5.82–8.08) mL/kg, p < 0.001] in the absence of PS, these changes appeared clinically irrelevant since the Comfort B score remained unaffected [12 (10–13) vs. 12 (10–13), P = 0.987]. Multivariable analysis showed that changes in WOBimp occurred independent of endotracheal tube size. Conclusions Withholding PS during ERT does not lead to clinically relevant increases in WOBimp, irrespective of endotracheal tube size.http://link.springer.com/article/10.1186/s13613-019-0549-0ChildMechanical ventilationImposed work of breathingExtubation readiness testPressure supportPaediatric intensive care |
| spellingShingle | Jefta van Dijk Robert G. T. Blokpoel Alette A. Koopman Sandra Dijkstra Johannes G. M. Burgerhof Martin C. J. Kneyber The effect of pressure support on imposed work of breathing during paediatric extubation readiness testing Annals of Intensive Care Child Mechanical ventilation Imposed work of breathing Extubation readiness test Pressure support Paediatric intensive care |
| title | The effect of pressure support on imposed work of breathing during paediatric extubation readiness testing |
| title_full | The effect of pressure support on imposed work of breathing during paediatric extubation readiness testing |
| title_fullStr | The effect of pressure support on imposed work of breathing during paediatric extubation readiness testing |
| title_full_unstemmed | The effect of pressure support on imposed work of breathing during paediatric extubation readiness testing |
| title_short | The effect of pressure support on imposed work of breathing during paediatric extubation readiness testing |
| title_sort | effect of pressure support on imposed work of breathing during paediatric extubation readiness testing |
| topic | Child Mechanical ventilation Imposed work of breathing Extubation readiness test Pressure support Paediatric intensive care |
| url | http://link.springer.com/article/10.1186/s13613-019-0549-0 |
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