ABSTRACT
OBJETIVO: Avaliar a razão entre espaço morto e volume corrente fisiológicos (V D/V T) como preditor do fracasso na extubação em 42 crianças ventiladas (idade média: 4,75 anos). MÉTODO: Prontidão para extubação foi determinada usando os critérios propostos pela 6ª Conferência Internacional de Consenso em Medicina Intensiva adaptados a crianças. RESULTADOS: A ventilação não invasiva (VNI) foi usada em quatro pacientes que desenvolveram insuficiência respiratória após a extubação; nenhum foi reintubado. Crianças que precisaram de VNI para evitar a reintubação tiveram razão V D/V T significativamente maior do que as que foram extubadas sem VNI (p < 0,001). O valor de corte da razão V D/V T foi 0,55, e a área sob a curva ROC foi 0,86. CONCLUSÃO: Nossos achados confirmam o bom valor preditivo do sucesso/fracasso do desmame pela razão V D/V T e sugere seu papel como preditor da necessidade de VNI após extubação.
OBJECTIVE: To evaluate the physiological deadspace/tidal volume ratio (V D/V T) as a predictor of extubation failure in 42 ventilated children (median age: 4.75 years). METHOD: Extubation readiness was determined using the criteria proposed by the 6th International Consensus Conference on Intensive Care Medicine adapted to children. RESULTS: Non-invasive ventilation (NIV) was used in four patients who developed respiratory failure after extubation; none was reintubated. Children who needed NIV to avoid reintubation had a significantly higher V D/V T ratio than those who were extubated without NIV (p < 0.001). The cut-off value of V D/V T ratio was 0.55 and the area under the receiver operating characteristic curve was 0.86. CONCLUSION: Our findings confirm the good predictive value of weaning success/failure of the V D/V T ratio and suggest its role for predicting the need for NIV after extubation.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Airway Extubation , Critical Care , Respiratory Insufficiency/therapy , Ventilator Weaning , Noninvasive Ventilation , Predictive Value of Tests , ROC Curve , Respiratory Dead Space/physiology , Tidal Volume/physiologyABSTRACT
OBJECTIVE: To evaluate the physiological deadspace/tidal volume ratio (VD/VT) as a predictor of extubation failure in 42 ventilated children (median age: 4.75 years). METHOD: Extubation readiness was determined using the criteria proposed by the 6th International Consensus Conference on Intensive Care Medicine adapted to children. RESULTS: Non-invasive ventilation (NIV) was used in four patients who developed respiratory failure after extubation; none was reintubated. Children who needed NIV to avoid reintubation had a significantly higher VD/VT ratio than those who were extubated without NIV (p < 0.001). The cut-off value of VD/VT ratio was 0.55 and the area under the receiver operating characteristic curve was 0.86. CONCLUSION: Our findings confirm the good predictive value of weaning success/failure of the VD/VT ratio and suggest its role for predicting the need for NIV after extubation.
Subject(s)
Airway Extubation , Critical Care , Respiratory Insufficiency/therapy , Ventilator Weaning , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Noninvasive Ventilation , Predictive Value of Tests , ROC Curve , Respiratory Dead Space/physiology , Tidal Volume/physiologyABSTRACT
Leigh syndrome is a genetically heterogeneous, neurodegenerative disorder that predominantly affects children and leads to death within months or years. Mutations causing this disease have been found in both mitochondrial and nuclear DNA. The present report describes a Tunisian family with a maternally inherited Leigh syndrome harboring the mitochondrial T8993G mutation in the ATPase 6 gene. Polymerase chain reaction-restriction fragment length polymorphism analysis with the MspI restriction endonuclease, quantified with a digital image analyzer and gel documentation system, showed that the T8993G mutation was present with a high percentage in the blood of the three patients tested. This mutation was also detected in the asymptomatic mothers of these three patients (90, 96, and 60%). Two novel mitochondrial mutations were identified in the mitochondrial ATP6 gene -- T8741G (L72R) and A8795G (H90R) -- and three novel polymorphisms. Altogether, Leigh syndrome presenting the T8993G mutation in the ATPase 6 gene with variable heteroplasmic loads (44-98%) in a single Tunisian family is a novel finding.
