Clinical study on the predictive utility of high flow CPAP in weaning from prolonged mechanical ventilation in critical paediatric surgery patients

Introduction and objectives

Weaning paediatric patients from mechanical ventilation (MV) often results in extubation failure (EF) (14%-22%) and 2% of patients will require tracheostomy (2%).

Methods

We performed an observational study in 115 critically ill patients in whom a novel high-flow CPAP (CPAP-ANRI) system was connected to the tracheal tube during ventilation (CPAP + TI). After extubation, the same system was connected to various interfaces.

Results

Mean (± SD) age was 31 ± 49 months, PRISM-III score was 2.9 ± 2.4, and duration of intermittent positive pressure ventilation with tracheal intubation (IPPV + TI) was 6 ± 5.6 days followed by CPAP + TI for 1.4 ± 1.7 days. The initial rate of EF was 10.4% for either haemodynamic (n = 4) or respiratory (n= 8) reasons, although the final rate of EF requiring tracheostomy was only 0.8%. After progressing from IPPV + TI to CPAP + TI, PO₂/FiO₂ values in successfully extubated patients immediately increased by 27% (p < 0.0003) vs only 13% (p > 0.3) in patients presenting EF. Switching to CPAP + TI increased the percentage of patients with pO₂/FiO₂ > 200, particularly in patients with heart disease, in whom >30% increase in pO₂/FiO₂ over baseline had a positive predictive value for successful extubation (AUC = 0.708; p = 0.056).

Conclusions

The CPAP-ANRI device is a simple respiratory aid that is highly effective in optimizing cardiopulmonary interaction to facilitate weaning from MV and identifying most cases in which extubation is likely to be successful.