1997 OPEN FORUM Abstracts
CLINICAL RESEARCH 'LMG' PROTOCOL FOR WEANING FROM MECHANICAL VENTILATION IN CHILDREN WITH NEURO-MUSCULAR PATHOLOGY
Luisa Maria Giorgetti PT, Claudia Rossello PT, Gustavo Olguin PT. Garrahan Pediatric Hospital, Physical Therapist Department. Buenos Aires, Argentina.
We have established a clinical research protocol (LMG) to systematize the weaning from mechanical ventilation of children with reversible and/or irreversible neuromuscular pathology. A retrospective analysis of 83 cases (1979-1988) revealed discordancy in (1) basic clinical/physiologic condition at the outset of weaning; (2) manner of evaluating respiratory mechanical effectiveness (DRME); (3) plan for training for weaning. Material & Methods: We decided to train the skeletal muscles. Criteria for entry into weaning training were (1) no acute pulmonary pathology for minimum of 48 h; stable MV PaO2 >= 60 mm Hg, PaCO2 < = 45 mm Hg, and SaO2 >= 95%. The score for DRME was derived from respiratory muscle assessment (RMA), RR, HR, and cough, problems with swallowing, and level of cooperation (incidents), rated from 4 to 0 points or good to non-existent. The sum of the individual values yields a score that reflects the sufficiency of the patient's respiratory mechanics, with 9-13 being Good; 4.5-8.5 Regular; 2-4 Poor; and 0-1.5 Vestige/Disappeared (or non-existent. Our plan for active training of respiratory muscles to fatigue is based on principle that affirms repetition of movements to 75% of the maximum sustainable load (ML), alternating with periods of rest, leads to progressive strengthening of weak muscles. Therefore, we replaced ML with a time limit for voluntary repetition (LT) without meaningful changes in RR and HR, that is working time (WT). The weaning training would consist of 3 periods in WT of voluntary respiration with or without supplemental oxygen according to need, alternated with periods of rest distributed over 12 hours daily on 2 successive days, respecting nocturnal MV. New LT and WT would be determined every 2 days, with the times of work and rest programmed until the patient is capable of 12 hours of voluntary respiration for 2 days and would then be considered weaned. Conclusion: we believe that the protocol allows us to quantify respiratory muscle effectiveness, plan a training program, and predict the time required for weaning.