Abstract
BACKGROUND: The dead-space-to-tidal-volume ratio (V(D)/V(T)) has been used to successfully predict extubation failure in children who are critically ill. However, a singular reliable measure to predict the level and duration of respiratory support after liberation from invasive mechanical ventilation has remained elusive. The objective of this study was to evaluate the association between V(D)/V(T) and the duration of postextubation respiratory support. METHODS: This was a retrospective cohort study of subjects who were mechanically ventilated and admitted to a single-center pediatric ICU between March 2019 and July 2021, and who had been extubated with a recorded V(D)/V(T). A cutoff of 0.30 was chosen a priori, with subjects divided into 2 groups, V(D)/V(T) < 0.30 and V(D)/V(T) ≥ 0.30, and postextubation respiratory support was recorded at specified time intervals (24 h, 48 h, 72 h, 7 d, and 14 d). RESULTS: We studied 54 subjects. Those with V(D)/V(T) ≥ 0.30 had a significantly longer median (interquartile range) duration of respiratory support after extubation (6 [3-14] d vs 2 [0-4] d; P = .001) and longer median (interquartile range) ICU stay (14 [12-19] d vs 8 [5-22] d; P = .046) versus the subjects with V(D)/V(T) < 0.30. The distribution of respiratory support did not differ significantly between V(D)/V(T) at the time of extubation (P = .13) or at 14 d after extubation (P = .21) but was significantly different during the intervening time points after extubation (24 h [P = .01], 48 h [P < .001], 72 h [P < .001], and 7 d [P = .02]). CONCLUSIONS: V(D)/V(T) was associated with the duration and level of respiratory support needed after extubation. Prospective studies are needed to establish if V(D)/V(T) can successfully predict the level of respiratory support after extubation.