Spontaneous Breathing Trial: A Reliable Method for Weaning in Children
چکیده
Introduction Mechanical ventilation may be lifesaving intervention. It can be associated with complications, thus, successful weaning is constitutive. One of the factors which are important in successful weaning is method of weaning. It is shown that weaning is conducted successfully by using Spontaneous breathing trial (SBT) through T-piece and Pressure support (PS) ventilation. But few studies have not accepted it. In this study, we evaluated the role of SBT in extubation of patients in Pediatric Intensive Care. Materials and Methods In a cross sectional and analytical study, three hundred sixty patients with adequate gas exchange [Indicated by PaO2 higher than 60 mm/Hg while FIO2 of 0.40 or less (or PaO2/FIO(2)ratio> 300)] were enrolled. Patients underwent a 2-hour trial of spontaneous breathing with pressure support ventilation. They were monitored during the test for 2 hours and were classified as failing the test if at any time in the 2-hour period, there was tachypnea, excessive work of breathing, tachycardia and SPO2<90%. Extubation failure was defined as needing reintubation within 72 hours of extubation. Results 240 patients (66%) of 360 patients successfully underwent SBT and were immediately extubated. In 120 patients (33%), the trial of spontaneous breathing was stopped (trial failure; 33% vs. 66% P=0.04). Of the 240 patients with successful SBT, 29 patients were re-intubated (extubation failure) and 211 patients had successful extubation (12% vs. 88% P=0.002). For patients experienced successful extubation, the mortality rate was 5% While the rate of mortality was 27% in patients with needing re-intubation(5% vs. 27% P=0.003). Conclusion The spontaneous breathing trial with pressure support prior to elective extubation may predict successful extubation in ventilated children.