2000 OPEN FORUM Abstracts
Predictors of Weaning Outcome from Mechanical Ventilation in the Pediatric Population
Mohamad Khatib, PhD, RCP American University of Beirut Medical Center, Beirut, Lebanon
The use of mechanical ventilation in the critically ill pediatric patients is a common and frequently lifesaving intervention. However, numerous negative side effects related to its use exist. Therefore, mechanical ventilation should be discontinued as soon as the patient can sustain spontaneous respiration with effective gas exchange.
It is important to know when a patient's medical condition is most compatible with a weaning trial and extubation. A weaning trial or extubation attempt undertaken too early may predispose the patient to severe cardio-respiratory and/or psychological decompensation while prolonged mechanical ventilation in a patient whose condition is compatible with a weaning trial exposes the patient to unnecessary risks.
The majority of studies related to predictability of weaning outcome have been conducted in the adult patients population and a multitude of univariate and multivariate parameters have been suggested. The most common of the univariate parameters include vital capacity, minute ventilation, maximal inspiratory pressure, airway occlusion pressure, static and dynamic compliance, etc. The newly developed multivariate parameters, such as the rapid shallow breathing and the CROP index, have been shown to be more powerful in predicting weaning outcome. Although the criteria and predictors developed for adult patients seem clinically applicable in the pediatric arena, caution should be observed not to directly extrapolate these indexes and criteria to the pediatric population. The presentation will be focused on identifying criteria and indexes for predicting outcome in pediatric patients. Also, the differences and modification to the criteria and indexes used for adult patients will be outlined.