Spontaneous breathing trial in the weaning process from mechanical ventilation in pediatrics: outcome and predictive factors. / Prueba de ventilación espontánea en el proceso de liberación de la asistencia ventilatoria mecánica en pediatría: resultados y factores predictores.

Introduction. spontaneous breathing trial (SBT) in weaning from pediatric invasive mechanical ventilation (IMV) is an endorsed practice, its positivity is based on clinical parameters; however, its results could be better documented. Objective. To describe the results of the SBT in the IMV weaning process. Population and methods. Retrospective analysis. Patients with ≥48 h in IMV from March 1, 2022 to January 31, 2024. Results. A total of493 SBT were analyzed in 304 patients; 71% (348) were positive, and 87% (302) resulted in successful extubations. The causes of negative SBT were increased work of breathing (70%), respiratory rate (57%), and heart rate (27%). In univariate analysis, respiratory distress as the reason for admission, peak inspiratory pressure before SBT and T-tube use, were predictors of negative SBT. In multivariate analysis, this association persisted for admission for respiratory cause, the higher programmed respiratory rate in IMV, as the T-tube modality. Those with negative SBT stayed more days in IMV (9 [7-12] vs. 7 [4-10]) and in PICU (11 [9-15] vs. 9 [7-12]). Conclusion. Positive SBT predicted successful extubation in a high percentage of cases. Respiratory distress on admission, higher programmed respiratory rate, and a higher proportion of T-tube mode were negative predictors of the test. Negative SBT was associated with more extended stays in IMV and PICU.

Introducción. La prueba de ventilación espontánea (PVE) en el proceso de liberación de la asistencia ventilatoria mecánica invasiva (AVMi) pediátrica es una práctica avalada; su positividad se sustenta en parámetros clínicos. Sin embargo, sus resultados están escasamente documentados. Objetivo. Describir los resultados de la PVE en el proceso de liberación de la AVMi. Población y métodos. Análisis retrospectivo. Pacientes con ≥ 48 h en AVMi del 1 de marzo de 2022 al 31 de enero de 2024. Resultados. Se analizaron 493 PVE en 304 pacientes; el 71 % (348) fueron positivas y el 87 % (302) redundó en extubaciones exitosas. Las causas de las PVE negativas fueron mayor trabajo respiratorio (70 %), frecuencia respiratoria (57 %) y frecuencia cardíaca (27 %). En el análisis univariado, la dificultad respiratoria como motivo de ingreso, la presión inspiratoria máxima previo a la PVE y el uso de tubo en T fueron predictores de PVE negativa. En el análisis multivariado, esta asociación persistió para el ingreso por causa respiratoria, la mayor frecuencia respiratoria programada en la AVM y la modalidad tubo en T. Quienes presentaron PVE negativas permanecieron más días en AVMi [9 (7-12) vs. 7 (4-10)] y en UCIP [11 (9-15) vs. 9 (7-12)]. Conclusión. La PVE positiva predijo la extubación exitosa en un alto porcentaje. La dificultad respiratoria al ingreso, la mayor frecuencia respiratoria programada y la mayor proporción de la modalidad tubo en T fueron predictores negativos para la prueba. La PVE negativa se asoció a mayor estadía en AVMi y UCIP.

A New Medical Device to Provide Independent Ventilation to Two Subjects Using a Single Ventilator: Evaluation in Lung-Healthy Pigs.

BACKGROUND: The global crisis situation caused by SARS-CoV-2 has created an explosive demand for ventilators, which cannot be met even in developed countries. Designing a simple and inexpensive device with the ability to increase the number of patients that can be connected to existing ventilators would have a major impact on the number of lives that could be saved. We conducted a study to determine whether two pigs with significant differences in size and weight could be ventilated simultaneously using a single ventilator connected to a new medical device called DuplicARⓇ. METHODS: Six pigs (median weight 12 kg, range 9-25 kg) were connected in pairs to a single ventilator using the new device for 6 hours. Both the ventilator and the device were manipulated throughout the experiment according to the needs of each animal. Tidal volume and positive end-expiratory pressure were individually controlled with the device. Primary and secondary outcome variables were defined to assess ventilation and hemodynamics in all animals throughout the experiment. RESULTS: Median difference in weight between the animals of each pair was 67% (range: 11-108). All animals could be successfully oxygenated and ventilated for 6 hours through manipulation of the ventilator and the DuplicARⓇ device, despite significant discrepancies in body size and weight. Mean PaCO2 in arterial blood was 42.1 ± 4.4 mmHg, mean PaO2 was 162.8 ± 46.8 mmHg, and mean oxygen saturation was 98 ± 1.3%. End-tidal CO2 values showed no statistically significant difference among subjects of each pair. Mean difference in arterial PaCO2 measured at the same time in both animals of each pair was 4.8 ± 3 mmHg, reflecting the ability of the device to ventilate each animal according to its particular requirements. Independent management of PEEP was achieved by manipulation of the device controllers. CONCLUSION: It is possible to ventilate two lung-healthy animals with a single ventilator according to each one's needs through manipulation of both the ventilator and the DuplicARⓇ device. This gives this device the potential to expand local ventilators surge capacity during disasters or pandemics until emergency supplies can be delivered from central stockpiles.