To evaluate the accuracy of the initial negative inspiratory pressure (PI) to maximal negative inspiratory pressure (PImax) ratio in predicting extubation outcome for intubated infants and children.
A prospective study. Setting: Pediatric intensive care unit.
A sample of 50 stable intubated pediatric patients who were judged clinically ready for extubation.
Using a one-way valve,PI andPImax were measured in all patients, after which the ≦ ratioPI/PImax was calculated and its accuracy in predicting extubation outcome evaluated.
Measurements and results
A total of 39 patients (78%) were successfully extubated and 11 patients (22%) were not. The meanPI/PImax ratio was not significantly different between extubation successes (0.36±0.14) and failures (0.45±0.1) (P>0.05). The cut-off value of 0.3 forPI/PImax identified in adult patients did not discriminate between extubation success and failure in children. Furthermore, a discriminatory cut-off value other than 0.3 could not be identified for infants and children.
ThePI/PImax ratio cannot be used to predict extubation outcome in pediatric patients. Indices that predict extubation outcome in adults should not be extrapolated to infants and children before testing and validation.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Slutsky AS (1993) Mechanical ventilation. ACCP consensus conference. Chest 104: 1833–1859
Tenney SM, Reese RE (1967) The ability to sustain great breathing efforts. Respir Physiol 5: 187–201
Sahn SA, Lakshminarayan S (1973) Bedside criteria for discontinuation of mechanical ventilation. Chest 63: 1002–1005
Tahvanainen J, Salmenpera M, Nikki P (1983) Extubation criteria after weaning from intermittent mandatory ventilation and continuous positive airway pressure. Cirt Care Med 11: 702–707
Fiastro JF, Habib MP, Shon BY, Campbell SC (1988) Comparison of standard weaning parameters and the mechanical work of breathing in mechanically ventilated patients. Chest 94: 232–238
Krieger BP, Ershowsky PF, Becker DA, Gazeroglu HB (1989) Evaluation of conventional criteria for predicting successful weaning from mechanical ventilatory support in elderly patients. Crit Care Med 17: 858–861
Morganroth ML, Morganroth JL, Nett LM, Petty TL (1984) Criteria for weaning from prolonged mechanical ventilation. Arch Intern Med 144: 1012–1016
Sassoon CS, Te TT, Mahutte CK, et al (1987) Airway occlusion pressure. An important indicator for successful weaning in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 135: 107–117
Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 324: 1445–1450
Yang KL (1993) Inspiratory pressure/ maximal inspiratory ratio: a predictive index of weaning outcome. Intensive Care Med 19: 204–208
Hermansen M (1990) Biostatistics: some basic concepts. Caduceus Medical Publishers, New York, pp 169–174
Khan N, Venkataraman S, Brown A (1994) Can bedside measures of respiratory function predict extubation success and failure in infants and children? (Abstract) Crit Care Med 22: A155
About this article
Cite this article
El-Khatib, M.F., Baumeister, B., Smith, P.G. et al. Inspiratory pressure/maximal inspiratory pressure: does it predict successful extubation in critically ill infants and children?. Intensive Care Med 22, 264–268 (1996). https://doi.org/10.1007/BF01712248
- Intensive care unit
- Mechanical ventilation
- Extubation outcome
- Pressure ratio