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Work of breathing during the weaning phase of paediatric mechanical ventilation
Keywords: mechanical ventilation Work of breathing Weaning
Researchers: J. van Dijk Dr. M.C.J. Kneyber
Nature of the research: Prospective observational study
Fields of study: pediatrics intensive care

Background / introduction

Medical care for critically ill children is often based on what works in adults. This may especially apply to mechanical ventilation. One of the aspects not supported by any rigorous scientific evidence is the approach to weaning the patient from the ventilator. In fact, reducing the exposure to mechanical ventilation (MV) through the initiation of weaning and timing of extubation has been largely neglected in the pediatric literature. The most common approach to weaning children is gradual reduction of ventilatory support by reducing the ventilatory rate. Another approach proposed is alternating periods of complete ventilatory support and graded spontaneous breathing with assistance. This “sprinting” is performed on the theory that the respiratory muscles can be trained in this way in a controlled fashion for short periods, enabling the muscles to take over spontaneous breathing completely for a while. Obviously, during the process of weaning the work of breathing should be as low as possible. Work of breathing is the physiologic work which a patient has to deliver to expand the lungs and the chest wall. Increased work of breathing results in failure of weaning and extubation. However, to date there is no data which of the two approaches of weaning has the lowest work of breathing in relation to clinical variables such as, for example, diagnoses where respiratory support is required. Knowledge of this could enhance individual titration of the weaning process, leading to faster and more successful extubations, and decreased lung damage. The aim of this study, therefore, is to provide more insights into the process of weaning pediatric patients from the ventilator by comparing the work of breathing between the two approaches of weaning.

Research question / problem definition
What is the difference in the level and time course of the work of breathing between the sprinting approach and the gradual reduction of ventilatory support?

Workplan

The student will participate in the research project of an MD/PhD student. The aim of the project is to support and help with the inclusion of patients, obtaining and analyzing the data and eventually the writing of an scientific report. The project will be performed at the pediatric intensive care unit of the Beatrix Children Hospital of the UMCG. The detailed workplan will be determined and discussed together with the student.
It is embedded within the research program CAPE: Critical care, Anaesthesiology, Peri-operative medicine and Emergency Medicine (directors: prof.dr. M.M.F. Struys and prof.dr. A.M.G.A. de Smet). This translational line of research focuses exclusively on paediatric mechanical ventilation and aims to study the use of mechanical ventilation in children and its short and long-term consequences.

References

1. Farias JA, Frutos F, Esteban A, et al. What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study. Intensive Care Med. 2004;30(5):918-925.
2. Turner DA, Arnold JH. Insights in pediatric ventilation: Timing of intubation, ventilatory strategies, and weaning. Curr Opin Crit Care. 2007;13(1):57-63.
3. Newth CJ, Venkataraman S, Willson DF, et al. Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med. 2009;10(1):1-11.
4. Baisch SD, Wheeler WB, Kurachek SC, Cornfield DN. Extubation failure in pediatric intensive care incidence and outcomes. Pediatr Crit Care Med. 2005;6(3):312-318.
5. Banner MJ, Jaeger MJ, Kirby RR. Components of the work of breathing and implications for monitoring ventilator-dependent patients. Crit Care Med. 1994;22(3):515-523

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