Inspiratory pressure/maximal inspiratory pressure: does it predict successful extubation in critically ill infants and children?

OBJECTIVE: To evaluate the accuracy of the initial negative inspiratory pressure (PI) to maximal negative inspiratory pressure (PImax) ratio in predicting extubation outcome for intubated infants and children.

DESIGN: A prospective study.

SETTING: Pediatric intensive care unit.

PATIENTS: A sample of 50 stable intubated pediatric patients who were judged clinically ready for extubation.

METHODS: Using a one-way valve, PI and PImax were measured in all patients, after which the < or = ratio PI/PImax was calculated and its accuracy in predicting extubation outcome evaluated.

MEASUREMENTS AND RESULTS: A total of 39 patients (78%) were successfully extubated and 11 patients (22%) were not. The mean PI/PImax ratio was not significantly different between extubation successes (0.36 +/- 0.14) and failures (0.45 +/- 0.1) (P > 0.05). The cut-off value of 0.3 for PI/PImax identified in adult patients did not discriminate between extubation success and failure in children. Furthermore, a discriminatory cut-off value other than 0.3 could not be identified for infants and children.

CONCLUSION: The PI/PImax ratio cannot be used to predict extubation outcome in pediatric patients. Indices that predict extubation outcome in adults should not be extrapolated to infants and children before testing and validation.