Spontaneous Breathing Trial a Reliable Method for Weaning in Children

Introduction  Mechanical ventilation may be lifesaving intervention,It can be associated with complications,Thus,successful weaning is constitutive.One of the factors which is  important in successful weaning is  method of weaning. It is shown that  weaning is conducted successfully by using Spontaneous Breathing Trial (SBT) through Tpiece and pressure support (PS) ventilation.But few studies have not accepted it.In this study,we evaluated the role of  SBT in extubation of patients in pediatric intensive care.  Materials and Methods In a cross sectional and analytical study, three hundred sixty  patients  with adequate gas exchange (indicated by PaO2 higher than 60 mm/Hg while FIO2 of 0.40 or less (or PaO2 ∕ FIO2ratio 300) were enrolled. Patients underwent a 2hours trial of spontaneous breathing with pressure support ventilation.They were monitored during the test for 2 hours and were classified as failing the test if at any time in the 2hours period ,there was tachypnea , excessive work of breathing,Tachycardia and SPO2 90%.Extubation  failure  was defind as needing reintubation  within 72 hours of extubation. Results  240 patients(66%) of 360 patients successfully underwent SBT and were immediately extubated.In 120 patients(33%) ,the trial of spontaneous breathing was stopped.(trial failure 33% vs. 66% P=0.04). Of the 240 patients with successful SBT,29 patients were reintubated (extubation failure) and 211 patients had successful extubation.(12% vs. 88% p=o.oo2).For patients experienced successful extubation ,the mortality rate was 5% While the rate of mortality was 27%  in patients with needing reintubation.(5% vs. 27% p= o.oo3) Conclusion The spontaneous breathing trial with pressure support prior to elective extubation may predict successful extubation in ventilated children.