Leonid Bederman, Monica Alvarez, Andrew G Miller, Elizabeth J Thompson, Rachel M Watts, Alexandre T Rotta, Karan R Kumar
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We hypothesized that an elevated V<sub>D</sub>/V<sub>T</sub> would be associated with longer duration and higher level of NRS following extubation in children with cardiac disease. <b>Methods:</b> We conducted a retrospective cohort study of mechanically ventilated patients admitted to our pediatric cardiac intensive care unit between March 2019 and July 2021 with at least one V<sub>D</sub>/V<sub>T</sub> recorded before extubation. Subjects were dichotomized a priori into two groups V<sub>D</sub>/V<sub>T</sub> < 0.30 and V<sub>D</sub>/V<sub>T</sub> ≥ 0.30. We recorded the type of NRS at 24 hours, 48 hours, 72 hours, 7 days, and 14 days after extubation. <b>Results:</b> We included 226 subjects. Median (IQR) weight was 4.1 (3.3-6.6) kg, 47% were female, 47% had cyanotic heart disease, and 90% were mechanically ventilated for respiratory failure or cardiac surgery. Subjects with V<sub>D</sub>/V<sub>T</sub> ≥ 0.30 experienced longer postextubation NRS (4 [1.9-9.1] vs 3 [1.2-5.3] days, <i>P</i> = .001) and were more likely to receive high-flow nasal cannula (67% vs 45%, <i>P</i> = .02) 24 hours following extubation. NRS modality immediately postextubation and reintubtion rates were similar between groups. Subjects with V<sub>D</sub>/V<sub>T</sub> ≥ 0.30 were younger (1.2 [0.1-3.6] vs 4.8 [1.2-30] months, <i>P</i> < .001) and more likely to have cyanotic congenital heart disease (59% vs 26%, <i>P</i> < .001). After adjusting for demographic and clinical characteristics, V<sub>D</sub>/V<sub>T</sub> was not associated with NRS use. <b>Conclusion:</b> V<sub>D</sub>/V<sub>T</sub> was not associated with the length of NRS after extubation or re-intubation after controlling for demographic and clinical differences.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association Between Dead Space to Tidal Volume Ratio and Duration of Respiratory Support After Extubation in Children With Congenital Heart Disease.\",\"authors\":\"Leonid Bederman, Monica Alvarez, Andrew G Miller, Elizabeth J Thompson, Rachel M Watts, Alexandre T Rotta, Karan R Kumar\",\"doi\":\"10.1177/19433654251362706\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background:</b> Children with cardiac disease liberated from mechanical ventilation often receive noninvasive respiratory support (NRS) postextubation via high-flow nasal cannula, CPAP, or noninvasive ventilation. Predicting the type and duration of postextubation NRS can be challenging due to a lack of objective tools to guide decision-making. The dead space to tidal volume ratio (V<sub>D</sub>/V<sub>T</sub>) is a potential tool to guide this decision. We hypothesized that an elevated V<sub>D</sub>/V<sub>T</sub> would be associated with longer duration and higher level of NRS following extubation in children with cardiac disease. <b>Methods:</b> We conducted a retrospective cohort study of mechanically ventilated patients admitted to our pediatric cardiac intensive care unit between March 2019 and July 2021 with at least one V<sub>D</sub>/V<sub>T</sub> recorded before extubation. Subjects were dichotomized a priori into two groups V<sub>D</sub>/V<sub>T</sub> < 0.30 and V<sub>D</sub>/V<sub>T</sub> ≥ 0.30. We recorded the type of NRS at 24 hours, 48 hours, 72 hours, 7 days, and 14 days after extubation. <b>Results:</b> We included 226 subjects. Median (IQR) weight was 4.1 (3.3-6.6) kg, 47% were female, 47% had cyanotic heart disease, and 90% were mechanically ventilated for respiratory failure or cardiac surgery. Subjects with V<sub>D</sub>/V<sub>T</sub> ≥ 0.30 experienced longer postextubation NRS (4 [1.9-9.1] vs 3 [1.2-5.3] days, <i>P</i> = .001) and were more likely to receive high-flow nasal cannula (67% vs 45%, <i>P</i> = .02) 24 hours following extubation. NRS modality immediately postextubation and reintubtion rates were similar between groups. Subjects with V<sub>D</sub>/V<sub>T</sub> ≥ 0.30 were younger (1.2 [0.1-3.6] vs 4.8 [1.2-30] months, <i>P</i> < .001) and more likely to have cyanotic congenital heart disease (59% vs 26%, <i>P</i> < .001). After adjusting for demographic and clinical characteristics, V<sub>D</sub>/V<sub>T</sub> was not associated with NRS use. <b>Conclusion:</b> V<sub>D</sub>/V<sub>T</sub> was not associated with the length of NRS after extubation or re-intubation after controlling for demographic and clinical differences.</p>\",\"PeriodicalId\":21125,\"journal\":{\"name\":\"Respiratory care\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-08-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Respiratory care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/19433654251362706\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Respiratory care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/19433654251362706","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景：脱离机械通气的心脏病患儿拔管后常通过高流量鼻插管、CPAP或无创通气接受无创呼吸支持（NRS）。由于缺乏指导决策的客观工具，预测拔管后NRS的类型和持续时间可能具有挑战性。死区与潮积比（VD/VT）是指导这一决策的潜在工具。我们假设VD/VT升高与心脏病患儿拔管后持续时间更长和NRS水平较高有关。方法：我们对2019年3月至2021年7月期间入住儿科心脏重症监护病房的机械通气患者进行了回顾性队列研究，这些患者在拔管前至少有一次VD/VT记录。将受试者先验分为VD/VT < 0.30和VD/VT≥0.30两组。分别于拔管后24小时、48小时、72小时、7天、14天记录NRS类型。结果：纳入226例受试者。中位（IQR）体重为4.1 (3.3-6.6)kg， 47%为女性，47%为紫绀型心脏病，90%因呼吸衰竭或心脏手术而机械通气。VD/VT≥0.30的受试者拔管后NRS较长（4[1.9-9.1]天和3[1.2-5.3]天，P = .001），拔管后24小时更有可能接受高流量鼻插管（67%对45%，P = .02）。两组间拔管后立即NRS模式和再拔管率相似。VD/VT≥0.30的受试者年龄更小（1.2[0.1-3.6]月vs 4.8[1.2-30]月，P < .001），更容易患紫绀型先天性心脏病（59% vs 26%, P < .001）。在调整了人口统计学和临床特征后，VD/VT与NRS的使用无关。结论：在控制人口统计学和临床差异后，VD/VT与拔管或再插管后NRS长度无关。
Association Between Dead Space to Tidal Volume Ratio and Duration of Respiratory Support After Extubation in Children With Congenital Heart Disease.
Background: Children with cardiac disease liberated from mechanical ventilation often receive noninvasive respiratory support (NRS) postextubation via high-flow nasal cannula, CPAP, or noninvasive ventilation. Predicting the type and duration of postextubation NRS can be challenging due to a lack of objective tools to guide decision-making. The dead space to tidal volume ratio (VD/VT) is a potential tool to guide this decision. We hypothesized that an elevated VD/VT would be associated with longer duration and higher level of NRS following extubation in children with cardiac disease. Methods: We conducted a retrospective cohort study of mechanically ventilated patients admitted to our pediatric cardiac intensive care unit between March 2019 and July 2021 with at least one VD/VT recorded before extubation. Subjects were dichotomized a priori into two groups VD/VT < 0.30 and VD/VT ≥ 0.30. We recorded the type of NRS at 24 hours, 48 hours, 72 hours, 7 days, and 14 days after extubation. Results: We included 226 subjects. Median (IQR) weight was 4.1 (3.3-6.6) kg, 47% were female, 47% had cyanotic heart disease, and 90% were mechanically ventilated for respiratory failure or cardiac surgery. Subjects with VD/VT ≥ 0.30 experienced longer postextubation NRS (4 [1.9-9.1] vs 3 [1.2-5.3] days, P = .001) and were more likely to receive high-flow nasal cannula (67% vs 45%, P = .02) 24 hours following extubation. NRS modality immediately postextubation and reintubtion rates were similar between groups. Subjects with VD/VT ≥ 0.30 were younger (1.2 [0.1-3.6] vs 4.8 [1.2-30] months, P < .001) and more likely to have cyanotic congenital heart disease (59% vs 26%, P < .001). After adjusting for demographic and clinical characteristics, VD/VT was not associated with NRS use. Conclusion: VD/VT was not associated with the length of NRS after extubation or re-intubation after controlling for demographic and clinical differences.
期刊介绍：
RESPIRATORY CARE is the official monthly science journal of the American Association for Respiratory Care. It is indexed in PubMed and included in ISI''s Web of Science.
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