Abstract
BACKGROUND: The present study aimed to characterize the behavior of 3 components of respiratory muscle function during mechanical ventilation weaning in children to better understand the respective impact of a spontaneous breathing trial on ventilatory mechanical action (esophageal pressure [Pes], ventilatory demand (electrical activity of the diaphragm [EAdi]), and oxygen consumption.
METHODS: This was a prospective single-center study. All children > 1 months and <18 y old who were intubated and on mechanical ventilation, and who were hospitalized in the pediatric ICU were eligible. Subjects considered as ready to extubate were included. Simultaneous recordings of oxygen consumption, Pes, and EAdi were performed during 3 steps: before, during, and after the spontaneous breathing test.
RESULTS: Twenty subjects (median age, 5.5 mo) were included. Half of them were admitted for a respiratory cause. The increase in Pes swings and esophageal pressure-time product during the spontaneous breathing trial was not significant (P = .33 and P = .75, respectively), and a similar trend was observed with peak EAdi (P = .06). Oxygen consumption obtained by indirect calorimetry was stable in the 3 conditions (P = .98).
CONCLUSIONS: In these children who were critically ill, a spontaneous breathing trial induced a moderate and nonsignificant increase in work of breathing, as reflected by the respiratory drive with EAdi and respiratory mechanics with Pes. However, indirect calorimetry did not seem to be a sensitive tool to assess respiratory muscle function during the weaning phase in children who were on mechanical ventilation, especially when work of breathing was slightly increased.
Footnotes
- Correspondence: Guillaume Mortamet MD PhD, Pediatric Intensive Care Unit, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada. E-mail: mortam{at}hotmail.fr.
The study was supported by the Réseau en Santé Respiratoire du Québec, the Assistance Publique des Hôpitaux de Paris, and the Fondation Sainte-Justine.
This work was performed in CHU Sainte-Justine, Pediatric Intensive Care Unit, Montreal, Quebec, Canada.
Dr Mortamet presented this work at the National Congress on Intensive Care Medicine, held on January 23–26, 2018, in Paris, France.
Dr Jouvet discloses relationships with the Fonds de Recherche du Québec – Santé, Ministry of Health, Sainte-Justine Hospital, Sage Therapeutic, Medunik, and Covidien. Dr Emeriaud discloses relationships with the Fonds de Recherche du Québec – Santé, and Maquet Critical Care. Dr Fauroux discloses relationships with Association Française contre les Myopathies, Assistance Publique-Hôpitaux de Paris, Inserm, Université Paris Descartes, ADEP Assistance, ASV Santé, S2A Santé, and IP Santé Domicile. The remaining authors have disclosed no conflicts of interest.
Supplementary material related to this paper is available at http://www.rcjournal.com.
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