An Interprofessional Quality Improvement Initiative to Standardize Pediatric Extubation Readiness Assessment

Abu‐Sultaneh, Samer; Hole, Acrista J; Tori, Alvaro J; Benneyworth, Brian D.; Lutfi, Riad; Mastropietro, Christopher W.

doi:10.1097/pcc.0000000000001285

Cited by 40 publications

(35 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ultrasound measurements and PImax were taken at the fifth minute after the start of SBT. The patient passed the SBT if the exhaled tidal volume was equal to or above 5 mL/kg of the ideal body weight, and if the respiratory rate remained within the targeted range for age (< 6 months, 20–50 breaths/min; 6 months-2 yr., 15–45 breaths/min; 2–5 yr., 15–40 breaths/min; > 5 yr. 10–35 breaths/min) [18]. All patients accepted the Venturi inside the mask for oxygen therapy after passing the SBT.…”

Section: Methodsmentioning

confidence: 99%

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

et al. 2019

View full text Add to dashboard Cite

IntroductionMultiple studies have shown that diaphragmatic ultrasound can better predict the outcome of weaning in adults. However, there are few studies focusing on children, leading to a lack of sufficient clinical evidence for the application of diaphragmatic ultrasound in children. The purpose of this study was to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children.MethodsThe study included 50 cases whose mechanical ventilation (MV) time was > 48 h, and all eligibles were divided into either the weaning success group (n = 39) or the weaning failure group (n = 11). Diaphragm thickness, diaphragmatic excursion (DE), and diaphragmatic thickening fraction (DTF) were measured in the zone of apposition. The maximum inspiratory pressure (PImax) was also recorded.ResultsThe ventilatory treatment time (P = 0.002) and length of PICU stay (P = 0.013) in the weaning failure group was longer than the success group. Cut-off values of diaphragmatic measures associated with successful weaning were ≥ 21% for DTF with a sensitivity of 0.82 and a specificity of 0.81, whereas it was ≥0.86 cm H2O/kg for PImax with a sensitivity of 0.51 and a specificity of 0.82. The linear correlation analysis showed that DTF had a significant positive correlation with PImax in children (P = 0.003).ConclusionsDiaphragm ultrasound has potential value in predicting the weaning outcome of critically ill children. DTF and PImax presented better performance than other diaphragmatic parameters. However, DE has limited value in predicting weaning outcomes of children with MV.Trial registrationCurrent Controlled Trials ChiCTR1800020196, (Dec 2018).

show abstract

Section: Methodsmentioning

confidence: 99%

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The patient passed the SBT if the exhaled tidal volume was equal to or above 5 mL/kg of the ideal body weight, and if the respiratory rate remained within the targeted range for age (<6 months 20-50 breaths/min; 6 months -2 yr. 15-45 breaths/min; 2 yr. -5 yr. breaths/min; >5 yr. 10-35 breaths/min). [18] All patients accepted the Venturi inside the mask for oxygen therapy after passing the SBT. Successful weaning was defined as the ability to maintain spontaneous breathing for >48 h.…”

Section: Methodsmentioning

confidence: 99%

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

Yang

Zhang

Sheng

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Multiple studies have shown that diaphragmatic ultrasound can better predict the outcome of weaning in adults. However, there are few studies focusing on children, leading to a lack of sufficient clinical evidence for the application of diaphragmatic ultrasound in children. The purpose of this study is to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. Methods: The study included 50 cases whose mechanical ventilation (MV) time was >48 h, and all eligibles were divided into either the weaning success group (n = 39) or the weaning failure group (n = 11). Diaphragm thickness, diaphragmatic excursion (DE), and diaphragmatic thickening fraction (DTF) were measured in the zone of apposition. The maximum inspiratory pressure (PImax) was also recorded. Results: The ventilatory treatment time ( P = 0.002) and length of PICU stay ( P = 0.013) in the weaning failure group was longer than the success group. Cut-off values of diaphragmatic measures associated with successful weaning were ≥21% for DTF with a sensitivity of 0.82 and a specificity of 0.81, whereas it was ≥0.86 cmH 2 O/kg for PImax with a sensitivity of 0.51 and a specificity of 0.82. The linear correlation analysis showed that DTF had significant correlation with PImax in children ( P = 0.003). Conclusions: Diaphragm ultrasound has great value in predicting the weaning outcome of critically ill children. DTF and PImax presented better performance than other diaphragmatic parameters. However, DE has limited value in predicting weaning outcomes of children with MV.

show abstract

“…[2] Ultrasound measurements and PImax were taken at the fifth minute after the start of breaths/min). [18] All patients accepted the Venturi inside the mask for oxygen therapy after passing the SBT. Successful weaning was defined as the ability to maintain spontaneous breathing for > 48 h.…”

Section: Methodsmentioning

confidence: 99%

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

Yang

Zhang

Sheng

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Multiple studies have shown that diaphragmatic ultrasound can better predict the outcome of weaning in adults. However, there are few studies focusing on children, leading to a lack of sufficient clinical evidence for the application of diaphragmatic ultrasound in children. The purpose of this study was to investigate the predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. Methods: Study included 50 cases whose mechanical ventilation(MV) time > 48 h, and all eligibles were divided into either the weaning success group (n = 39) or the weaning failure group (n = 11). Diaphragm thickness and diaphragmatic excursion (DE) were measured in the zone of apposition. The maximum inspiratory pressure (PImax) was also recorded. Results: The ventilatory treatment time (P = 0.002) and length of PICU stay (P = 0.013) in the weaning failure group was longer than the success group. Cut-off values of diaphragmatic measures associated with successful weaning were ≥ 21% for DTF with a sensitivity of 0.82, and a specificity of 0.81, whereas it was ≥ 8.40 mm for DE with a sensitivity of 0.62, and a specificity of 0.91. The linear correlation analysis showed that DTF had no significant correlation with PImax in children (P = 0.31). Conclusions: Diaphragm ultrasound has great value in predicting the weaning outcome of critically ill children. DTF and DE presented better performance than other diaphragmatic parameters. However, PImax has limited value in terms of reflecting the inspiratory muscle function of children with MV. Trial Registration: The trial ‘Early rehabilitation intervention for critically ill children’ has been registered at http://www.chictr.org.cn/showproj.aspx?proj=23132. Registration number: ChiCTR1800020196. Key words: Paediatric; mechanical ventilation; diaphragm; ultrasound; weaning; PImax

show abstract

An Interprofessional Quality Improvement Initiative to Standardize Pediatric Extubation Readiness Assessment

Abstract: An interprofessionally developed respiratory therapist-led extubation readiness protocol can be successfully implemented in a busy tertiary care PICU without adverse events.

Cited by 40 publications

References 30 publications

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children

Contact Info

Product

Resources

About