الفهرس 
MECHANICAL VENTILATIONOnly 14 pages are availabe for public view
 |  | from | 128 |  |  |
| | | from | 128 | | |
Abstract
A
lthough mechanical ventilation is a life-saving intervention for pediatric patients suffering from acute respiratory failure, it is associated with numerous grave complications and should be discontinued at the earliest possible time. However, both delayed and premature weaning may be harmful, so the need for accurate prediction of weaning outcome is important.
The pathophysiology underlying weaning failure is complex and the cardiac function and, more importantly, volume status may play a role in this setting.
The present study prospectively studied 20 mechanically ventilated infants and children who are mechanically ventilated for more than 24 hours and were considered ready to undergo a one hour spontaneous breathing trial (SBT).
According to the results of SBT and extubation the patients were classified into successful weaning which included 12 patients (60%), successful SBT but failed weaning which included 3 patients (15%) and failed SBT and weaning which included 5 patients (25%).
In this study it was found that 80% of ventilated infants and children can be disconnected from ventilator support after a trial of spontaneous breathing trial lasting one hour. Also it was found a statistical significant higher mean rapid shallow breathing index (RSBI) in cases with failed weaning when compared to successful weaning.
The present study identified NT-proBNP as independent risk factor for weaning failure .In this study it was found that patients with failed weaning have statistically significant higher mean NT-proBNP value (643±309) when compared to patients with successful weaning (200±122).
N-terminal pro-brain natriuretic peptide (NT-proBNP) is a sensitive indicator of cardiac dysfunction and is released from the cardiac ventricles in response to myocyte stretch and its plasma level has been correlated to left-ventricular filling pressures.
The abnormalities of systolic and diastolic function are frequent in critically ill patients and may play a role in patients failing weaning from mechanical ventilation.
Withdrawal of mechanical ventilation has several physiological consequences that may challenge the cardiovascular system during weaning and unmask subclinical systolic, diastolic dysfunction and/or fluid overload.