Andrew Miller, MS, RRT
Respiratory Care Practitioner, ECMO Specialist
Duke University Medical Center
Durham, North Carolina
Disclosure information not submitted.
Olivia Marshburn, RRT
Respiratory Care Practitioner, Advanced
Duke University Medical Center, United States
Disclosure information not submitted.
Jessica Brown, RRT
Respiratory Care Practitioner, ECMO Specialist
Duke University Medical Center, United States
Disclosure information not submitted.
Dirk Mattin, RRT
Respiratory Care Practitioner, ECMO Specialist
Duke University Medical Center, United States
Disclosure information not submitted.
Jeanette Muddiman, RRT
Respiratory Care Practitioner, Advanced
Duke University Medical Center, United States
Disclosure information not submitted.
Veera Allareddy, MBBS
Chief of the Section of Pediatric Cardiac Care
Duke University Medical Center, United States
Disclosure information not submitted.
Alexandre Rotta, MD, FCCM
Chair, SCCM Pediatric Section
Duke University Medical Center, United States
Disclosure information not submitted.
Title: Effect of Reducing Pressure Support During ERT in Children with Congenital Heart Disease
Introduction: Daily extubation readiness testing (ERT) is performed in our pediatric cardiac ICU as part of our ventilator protocol. Historically we used different pressure support (PS) levels (6, 8, or 10 cmH20), inversely related to endotracheal tube (ETT) size. Based on data showing the resistance of appropriately sized ETTs is similar to the natural airway, we changed our ERT method to use 5 cmH2O of PS and 5 cmH2O of PEEP regardless of ETT size. We hypothesized that this change would not adversely affect liberation from mechanical ventilation.
Methods: We performed a before/after study following IRB approval that included all subjects who received mechanical ventilation in our PCICU. Data were collected on demographics, surgical status, fluid balance, respiratory support at extubation, and need for reintubation. The primary outcome was need for reintubation. Secondary outcomes included time on mechanical ventilation and percentage of ERTs passed. Continuous variables are presented as counts (%), mean ± SD, or median (IQR). Data were analyzed using chi-square, t-test, or Mann-Whitney test.
Results: There were a total of 183 subjects in the pre- and 123 in the post PS change group. Subjects in the post group were younger (1[0-5] vs 2[0-7] months, p=0.043), had higher STAT category (16% v 7.1% STAT 5, p=0.028), and had higher respiratory support at extubation (9% vs 3.3% BiPAP, p=0.032) compared to the pre group. Ventilator settings were similar between groups at ERT eligibility, except for higher VD/VT in the post group (0.36 ± 0.1 vs. 0.32 ± 0.1, p< 0.001). There was no difference for the rate of reintubation (12% vs 8.2%, p=0.25). Time on mechanical ventilation was longer in the post group (3.9 vs 3.1 days, p=0.019) and a higher percentage of subjects failed their ERTs (36% vs. 28%, p=0.026).
Conclusions: Reducing the PS during ERTs did not affect the rate of extubation failure, yet a lower percentage of ERTs were passed and subjects spent longer on the ventilator. The post group received higher respiratory support and failed more ERTs, suggesting it may represent a cohort with higher illness severity.