2. Respiratory failures are important conditions
for pediatric mortalities and morbidities.
It constitutes an important cause of pediatric
mortality in hospitals worldwide.
There is abrupt respiratory failure due to
intra-parenchymal lung damage or sequential
signs ofVentilation perfusion mismatch in
case of partially treated LRTI.
3. Respiratory failure happens when the respiratory
system fails to maintain gas exchange and is classified
into type 1 and type 2 according to blood gases
abnormalities.
In type 1 (hypoxemic) respiratory failure, the partial
pressure of arterial oxygen (PaO2) is less than 60
millimeters of mercury (mmHg), and the partial
pressure of arterial carbon dioxide (PaCO2) may be
either normal or low.
In type 2 (hypercapnic) respiratory failure, the PaCO2
is greater than 50 mmHg, and PaO2 may be normal
or, in the event of respiratory pump failure, low
4. The major intervention to prevent morbidity
and death due to respiratory failure is
mechanical ventilation (MV).
It can be associated with complications such
as ventilator-induced lung injury and
nosocomial pneumonia.
Therefore, it is important that MV be
discontinued as soon as the patient is capable
of sustaining spontaneous breathing.
5. Although expeditious weaning and
extubation are the goal, premature
extubation can be lethal.
6. Weaning is the transition from ventilatory
support to completely spontaneous
breathing, during which time the patient
assumes the responsibility for effective gas
exchange while positive pressure support is
withdrawn.
Note that spontaneous breathing is a
prerequisite for weaning to begin and
decreasing ventilator support is not the sole
criterion of successful weaning
7. Extubation is the removal of the endotracheal tube.
Criteria for extubation include spontaneous
ventilation, hemodynamic stability, intact airway
reflexes, and manageable airway secretions.
Success is defined as 48 hrs of spontaneous breathing
without positive pressure support.
Early extubation failure is defined as that which
occurs within 6 hrs of extubation; intermediate
extubation failure is that which occurs from 6 to 24 hrs
of extubation; and late extubation failure is defined as
that which occurs from 24 to 48 hrs of extubation
8. Spontaneous breathing test is a subjective
determination of whether the underlying
disease process necessitating mechanical
ventilation has improved sufficiently to allow
the patient adequate gas exchange with
spontaneous breathing.
9.
10. Intravascular fluid status
Cumulative fluid balance
Positive End expiratory pressure
Low tidal volume
Lung protective strategy
Duration of sedation
Central Respiratory drive
Pulmonary hypertension
Diaphragmatic Dysfunction
Disease Reversibility
Associated Cardiac or CNS lesions
11. Level of PEEP applied
Value of pressure support applied
Respiratory rate
Extubation ReadinessTest
Concept ofVentilator free days
Use of CPAP support
12. Age < 24 months
Dysgenetic or syndromic condition
Chronic respiratory disorder
Chronic neurologic condition
And the need to replace the ETT at admission
for any reason
13. Extubation failure, defined as re-intubation
within 48 hrs was associated with
younger age
mean oxygenation index (OI) 5
longer duration of MV (15 days)
increased sedation (10 days),
use of inotropes.
14. Proposed criteria for failure during 2 hrs on Continuous
positive airway pressure 5 cm H2O orT-piece (zero end-
expiratory pressure)
Clinical criteria
Diaphoresis
Nasal flaring
Increasing respiratory effort
Tachycardia (increase in HR 40 bpm)
Cardiac arrhythmias
Hypotension
Apnea
Laboratory criteria
Increase of PETCO2 10 mm Hg
Decrease of arterial pH 7.32
Decline in arterial pH 0.07
PaO2 60 mm Hg with an FIO2 0.40 (P/F O2 ratio 150)
SpO2 declines 5%
15. Good respiratory muscular efforts
Leak test around ETT
Negative inspiratory force
Use of Non Invasive MV
Low lung volume
Intra-abdominal hypertension
Cerebral perfusion pressure
16. Good lung expansion on CXR
Normal cardiac function
Good sensorium
Good kidney and hepatic function
Off inotropes
Off sedation
No fever
Improved abdominal pathology if any
17. Individual prototypes for weaning of
paediatric patients depends upon clinical
evaluation and knowledge of treating
consultants along-with radiological and
laboratory collaboration.