ROX index as a predictor of failure of high-flow nasal cannula in infants with bronchiolitis.

High-flow nasal cannula (HFNC) is a relatively recent therapy that has been used to treat respiratory failure. Until now, the criterion for failure requiring escalation to other forms of ventilatory support has remained unclear. This study evaluated how the ROX index predicts the success or failure of HFNC in infants with bronchiolitis. A prospective, observational, multicenter study was conducted in 2 pediatric ICUs. The data were collected at 7 moments. Patients were categorized into failure and success groups according to HFNC. A total of 102 infants were included, 18(17.6%) of whom failed HFNC therapy. For the ROX index, significant differences were observed between the failure 5.8(95%CI 4.7-7.1) and success 7.7(95%CI 7.2-8.2) groups (p = 0.005) at the 12 h evaluation. According to the analysis of the performance of the ROX index, the AUC at 12 h was 0.716(95%CI 0.591-0.842; p = 0.016). The best cutoff range for the ROX index at 12 h was 6.50-7.18, with a sensitivity of 42% and a specificity of 66% at the cutoff of 6.50, and a sensitivity of 92% and a specificity of 54% at the cutoff of 7.18. We concluded that the ROX index could be effective at predicting the failure of HFNC therapy in infants with bronchiolitis beginning at 12 h after installation.

Spontaneous breathing test in the prediction of extubation failure in the pediatric population.

OBJECTIVE: To assess whether the spontaneous breathing test can predict the extubation failure in pediatric population. METHODS: A prospective and observational study that evaluated data of inpatients at the Pediatric Intensive Care Unit between May 2011 and August 2013, receiving mechanical ventilation for at least 24 hours followed by extubation. The patients were classified in two groups: Test Group, with patients extubated after spontaneous breathing test, and Control Group, with patients extubated without spontaneous breathing test. RESULTS: A total of 95 children were enrolled in the study, 71 in the Test Group and 24 in the Control Group. A direct comparison was made between the two groups regarding sex, age, mechanical ventilation time, indication to start mechanical ventilation and respiratory parameters before extubation in the Control Group, and before the spontaneous breathing test in the Test Group. There was no difference between the parameters evaluated. According to the analysis of probability of extubation failure between the two groups, the likelihood of extubation failure in the Control Group was 1,412 higher than in the Test Group, nevertheless, this range did not reach significance (p=0.706). This model was considered well-adjusted according to the Hosmer-Lemeshow test (p=0.758). CONCLUSION: The spontaneous breathing test was not able to predict the extubation failure in pediatric population. OBJETIVO: Avaliar se o teste de respiração espontânea pode ser utilizado para predizer falha da extubação na população pediátrica. MÉTODOS: Estudo prospectivo, observacional, no qual foram avaliados todos os pacientes internados no Centro de Terapia Intensiva Pediátrica, no período de maio de 2011 a agosto de 2013, que utilizaram ventilação mecânica por mais de 24 horas e que foram extubados. Os pacientes foram classificados em dois grupos: Grupo Teste, que incluiu os pacientes extubados depois do teste de respiração espontânea; e Grupo Controle, pacientes foram sem teste de respiração espontânea. RESULTADOS: Dos 95 pacientes incluídos no estudo, 71 crianças eram do Grupo Teste e 24 eram do Grupo Controle. Os grupos foram comparados em relação a: sexo, idade, tempo de ventilação mecânica, indicação para início da ventilação mecânica e parâmetros ventilatórios pré-extubação, no Grupo Controle, e pré-realização do teste, no Grupo Teste. Não foram observadas diferenças entre os parâmetros analisados. Em relação à análise da probabilidade de falha da extubação entre os dois grupos de estudo, a chance de falha do Grupo Controle foi 1.412 maior do que a das crianças do Grupo Teste, porém este acréscimo não foi significativo (p=0,706). O modelo foi considerado bem ajustado de acordo com o teste de Hosmer-Lemeshow (p=0,758). CONCLUSÃO: O teste de respiração espontânea para a população pediátrica não foi capaz de prever a falha da extubação.

Manual Ventilation and Sustained Lung Inflation in an Experimental Model: Influence of Equipment Type and Operator's Training.

AIM: To compare the influence of devices for manual ventilation and individual experience on the applied respiratory mechanics and sustained lung inflation. METHODS: A total of 114 instructors and non-instructors from the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics participated in this study. Participants ventilated an intubated manikin. To evaluate respiratory mechanics and sustained lung inflation parameters, a direct comparison was made between the self-inflating bag and the T-shaped resuscitator (T-piece), followed by an analysis of the effectiveness of the equipment according to the participants' education and training. RESULTS: A difference between equipment types was observed for the tidal volume, with a median (interquartile range) of 28.5 mL (12.6) for the self-inflating bag and 20.1 mL (8.4) for the T-piece in the instructor group and 31.6 mL (14) for the self-inflating bag and 22.3 mL (8.8) for the T-piece in the non-instructor group. Higher inspiratory time values were observed with the T-piece in both groups of professionals, with no significant difference between them. The operator's ability to maintain the target pressure over the 10 seconds of sustained lung inflation was evaluated using the area under the pressure-time curve and was 1.7-fold higher with the use of the T-piece. Inspiratory pressure and mean airway pressure applied during sustained lung inflation were greater with the self-inflating bag, as evaluated between the beginning and the end of the procedure. CONCLUSION: The T-piece resulted in lower tidal volume and higher inspiratory time values, irrespective of the operator's experience, and increased the ease of performing the sustained lung inflation maneuver, as demonstrated by the maintenance of target pressure for the desired period and a higher mean airway pressure than that obtained using the self-inflating bag.

Spontaneous breathing test in the prediction of extubation failure in the pediatric population / Teste de respiração espontânea na previsão de falha de extubação em população pediátrica

ABSTRACT Objective To assess whether the spontaneous breathing test can predict the extubation failure in pediatric population. Methods A prospective and observational study that evaluated data of inpatients at the Pediatric Intensive Care Unit between May 2011 and August 2013, receiving mechanical ventilation for at least 24 hours followed by extubation. The patients were classified in two groups: Test Group, with patients extubated after spontaneous breathing test, and Control Group, with patients extubated without spontaneous breathing test. Results A total of 95 children were enrolled in the study, 71 in the Test Group and 24 in the Control Group. A direct comparison was made between the two groups regarding sex, age, mechanical ventilation time, indication to start mechanical ventilation and respiratory parameters before extubation in the Control Group, and before the spontaneous breathing test in the Test Group. There was no difference between the parameters evaluated. According to the analysis of probability of extubation failure between the two groups, the likelihood of extubation failure in the Control Group was 1,412 higher than in the Test Group, nevertheless, this range did not reach significance (p=0.706). This model was considered well-adjusted according to the Hosmer-Lemeshow test (p=0.758). Conclusion The spontaneous breathing test was not able to predict the extubation failure in pediatric population.

RESUMO Objetivo Avaliar se o teste de respiração espontânea pode ser utilizado para predizer falha da extubação na população pediátrica. Métodos Estudo prospectivo, observacional, no qual foram avaliados todos os pacientes internados no Centro de Terapia Intensiva Pediátrica, no período de maio de 2011 a agosto de 2013, que utilizaram ventilação mecânica por mais de 24 horas e que foram extubados. Os pacientes foram classificados em dois grupos: Grupo Teste, que incluiu os pacientes extubados depois do teste de respiração espontânea; e Grupo Controle, pacientes foram sem teste de respiração espontânea. Resultados Dos 95 pacientes incluídos no estudo, 71 crianças eram do Grupo Teste e 24 eram do Grupo Controle. Os grupos foram comparados em relação a: sexo, idade, tempo de ventilação mecânica, indicação para início da ventilação mecânica e parâmetros ventilatórios pré-extubação, no Grupo Controle, e pré-realização do teste, no Grupo Teste. Não foram observadas diferenças entre os parâmetros analisados. Em relação à análise da probabilidade de falha da extubação entre os dois grupos de estudo, a chance de falha do Grupo Controle foi 1.412 maior do que a das crianças do Grupo Teste, porém este acréscimo não foi significativo (p=0,706). O modelo foi considerado bem ajustado de acordo com o teste de Hosmer-Lemeshow (p=0,758). Conclusão O teste de respiração espontânea para a população pediátrica não foi capaz de prever a falha da extubação.

Bubble CPAP versus CPAP with variable flow in newborns with respiratory distress: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy and safety of nasal continuous positive airway pressure (NCPAP) using devices with variable flow or bubble continuous positive airway pressure (CPAP) regarding CPAP failure, presence of air leaks, total CPAP and oxygen time, and length of intensive care unit and hospital stay in neonates with moderate respiratory distress (RD) and birth weight (BW) ≥ 1,500 g. METHODS: Forty newborns requiring NCPAP were randomized into two study groups: variable flow group (VF) and continuous flow group (CF). The study was conducted between October 2008 and April 2010. Demographic data, CPAP failure, presence of air leaks, and total CPAP and oxygen time were recorded. Categorical outcomes were tested using the chi-square test or the Fisher's exact test. Continuous variables were analyzed using the Mann-Whitney test. The level of significance was set at p < 0.05. RESULTS: There were no differences between the groups with regard to demographic data, CPAP failure (21.1 and 20.0% for VF and CF, respectively; p = 1.000), air leak syndrome (10.5 and 5.0%, respectively; p = 0.605), total CPAP time (median: 22.0 h, interquartile range [IQR]: 8.00-31.00 h and median: 22.0 h, IQR: 6.00-32.00 h, respectively; p = 0.822), and total oxygen time (median: 24.00 h, IQR: 7.00-85.00 h and median: 21.00 h, IQR: 9.50-66.75 h, respectively; p = 0.779). CONCLUSION: In newborns with BW ≥ 1,500 g and moderate RD, the use of continuous flow NCPAP showed the same benefits as the use of variable flow NCPAP.

CPAP em selo d'água versus CPAP com fluxo variável em recém-nascidos com desconforto respiratório: um ensaio controlado randomizado / Bubble CPAP versus CPAP with variable flow in newborns with respiratory distress: a randomized controlled trial

OBJETIVO: Avaliar a eficácia e segurança da pressão positiva contínua na via aérea (CPAP) utilizando aparelhos de fluxo variável e fluxo contínuo em selo d'água, quanto a falha do CPAP, ocorrência de escape de ar, tempo de uso de CPAP e de oxigênio e tempo de internação em unidade de terapia intensiva e hospitalar em neonatos com desconforto respiratório (DR) moderado e peso de nascimento (PN) > 1.500 g. MÉTODOS: Quarenta recém-nascidos que necessitavam de CPAP foram randomizados em dois grupos: um grupo tratado com fluxo variável (FV) e outro com fluxo contínuo (FC). O estudo foi realizado entre outubro de 2008 e abril de 2010. Foram registrados dados demográficos, falha do CPAP, ocorrência de escape de ar, tempo de uso de CPAP e de oxigênio, entre outros. Os desfechos categóricos foram analisados com o teste do qui-quadrado ou exato de Fisher e as variáveis contínuas com o teste de Mann-Whitney, com significância de p < 0,05. RESULTADOS: Não houve diferença quanto aos dados demográficos, falha do CPAP (21,1 e 20,0% para o FV e o FC, respectivamente; p = 1,000), síndrome de escape de ar (10,5 e 5,0%, respectivamente; p = 0,605), tempo de CPAP [mediana: 22,0 h, intervalo interquartil (IIQ): 8,00-31,00 h e mediana: 22,0 h, IIQ: 6,00-32,00 h, respectivamente; p = 0,822), e tempo de uso de oxigênio (mediana: 24,00 h, IIQ:7,00-85,00 h e mediana: 21,00 h, IIQ:9,50-66,75 h, respectivamente; p = 0,779). CONCLUSÃO: Em recém-nascidos com PN > 1.500 g e DR moderado, o CPAP nasal com fluxo contínuo apresentou os mesmos benefícios do CPAP nasal com fluxo variável.

OBJECTIVE: To evaluate the efficacy and safety of nasal continuous positive airway pressure (NCPAP) using devices with variable flow or bubble continuous positive airway pressure (CPAP) regarding CPAP failure, presence of air leaks, total CPAP and oxygen time, and length of intensive care unit and hospital stay in neonates with moderate respiratory distress (RD) and birth weight (BW) > 1,500 g. METHODS: Forty newborns requiring NCPAP were randomized into two study groups: variable flow group (VF) and continuous flow group (CF). The study was conducted between October 2008 and April 2010. Demographic data, CPAP failure, presence of air leaks, and total CPAP and oxygen time were recorded. Categorical outcomes were tested using the chi-square test or the Fisher's exact test. Continuous variables were analyzed using the Mann-Whitney test. The level of significance was set at p < 0.05. RESULTS: There were no differences between the groups with regard to demographic data, CPAP failure (21.1 and 20.0% for VF and CF, respectively; p = 1.000), air leak syndrome (10.5 and 5.0%, respectively; p = 0.605), total CPAP time (median: 22.0 h, interquartile range [IQR]: 8.00-31.00 h and median: 22.0 h, IQR: 6.00-32.00 h, respectively; p = 0.822), and total oxygen time (median: 24.00 h, IQR: 7.00-85.00 h and median: 21.00 h, IQR: 9.50-66.75 h, respectively; p = 0.779). CONCLUSION: In newborns with BW > 1,500 g and moderate RD, the use of continuous flow NCPAP showed the same benefits as the use of variable flow NCPAP.