About This Project

Most of patients admitted in Pediatric Intensive Care Unit require mechanical ventilation. Because it may lead to severe complications, it is important that mechanical ventilation be discontinued as soon as the patient is capable of sustaining spontaneous breathing. We are studying a new and noninvasive tool to assess the patient's respiratory effort in order to optimize the timing to remove the previously inserted endotracheal tube.

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What is the context of this research?

Every year, more than 300,000 children are hospitalized in Pediatric Intensive Care Unit in North America (Odetola, 2005), and a majority of them require mechanical ventilation, regardless the reason of admission. Mechanical ventilation may lead to severe complications (secondary lung injury, diaphragm dysfunction, etc) that is why it should be discontinued as soon as possible. However, criteria to diagnose extubation readiness are lacking. The monitoring of work of breathing during the weaning phase of ventilation allows us to determine the capacity of the patient to assume the ventilation. Therefore, work of breathing monitoring has the potential to be an important tool to accelerate the extubation process. However, its assessment is not easy in clinical practice.

What is the significance of this project?

Pediatric studies regarding the management of mechanical ventilation are lacking. In particular, the assessment of the patient’s respiratory effort during mechanical ventilation is actually scarcely reported. Such information is necessary to guide the adaptation of the settings in children. This original project aims to fulfill the lack of data in this field. We expect that the Indirect Calorimetry-based less invasive method will provide an accurate estimation of work of breathing. Once validated, this tool could be rapidly used to optimize the timing of extubation, and future trial will study its potential aiming to reduce the duration of ventilation, the length of stay in Pediatric Intensive Care Unit and mortality.

What are the goals of the project?

The primary objective of this study is to validate the reliability of a new method (Indirect Calorimetry) to assess the ability of patients to breath spontaneously and efficiently. We will compare this technology with 2 other methods (esophageal pressure measurement and Electrical Activity of the diaphragm, already known as good surrogates to assess work of breathing) during a routine extubation readiness test. Our final goal is to earlier identify patients able to be extubated and patients in whom extubation is unsafe.