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 inspirator y 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. P atients: A sample of 50 stable intubated pediatric patients who were j udged clinically ready for extubation. Methods: Using a one-way valve, PI and PImax were measured in all patients, after which the less than or equal to ratio P-I/PImax was calculated and its accuracy in predic ting extubation outcome evaluated. Measurements and results: A total o f 39 patients (78%) were successfully extubated and 11 patients (22%) were not. The mean P-I/PImax ratio was not significantly different bet ween extubation successes (0.36 +/- 0.14) and failures (0.45) +/- 0.1) (P > 0.05). The cut-off value of 0.3 for P-I/PImax identified in adul t 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 P -I/PImax ratio cannot be used to predict extubation outcome in pediatr ic patients. Indices that predict extubation outcome in adults should not be extrapolated to infants and children before testing and validat ion.