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.