Evidence map›Paper›PMID 27318942›Full record

ArticleIntensive care medicine2016

Pediatric extubation readiness tests should not use pressure support.

Robinder G Khemani, Justin Hotz, Rica Morzov, Rutger C Flink, Asvari Kamerkar, Marie LaFortune, Gerrard F Rafferty, Patrick A Ross, Christopher J L Newth

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In one paragraph

Article in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
52citing papers in PubMed, 4 pooled it
11.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

52 citing papers in PubMed, 4 syntheses or guidelines pooled it, 105 citations in OpenAlex.

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  15. Esophageal Manometry in Pediatric Acute Respiratory Distress Syndrome: Necessity or Simply a Neighbor of the Pulmonary Artery Catheter?Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2025
    Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 3 countries.

Robinder G KhemaniDepartment of Anesthesiology and Critical Care, Children's Hospital Los Angeles, 4650 Sunset Blvd Mailstop 12, Los Angeles, CA, 90027, USA. rkhemani@chla.usc.edu.ORCID http://orcid.org/0000-0002-5815-0314
Justin HotzDepartment of Anesthesiology and Critical Care, Children's Hospital Los Angeles, 4650 Sunset Blvd Mailstop 12, Los Angeles, CA, 90027, USA.
Rica MorzovDepartment of Anesthesiology and Critical Care, Children's Hospital Los Angeles, 4650 Sunset Blvd Mailstop 12, Los Angeles, CA, 90027, USA.
Rutger C FlinkMed-E Link, Amsterdam, The Netherlands.
Asvari KamerkarDepartment of Anesthesiology and Critical Care, Children's Hospital Los Angeles, 4650 Sunset Blvd Mailstop 12, Los Angeles, CA, 90027, USA.
Marie LaFortuneDepartment of Anesthesiology and Critical Care, Children's Hospital Los Angeles, 4650 Sunset Blvd Mailstop 12, Los Angeles, CA, 90027, USA.
Gerrard F RaffertyDepartment of Respiratory Medicine, King's College London, London, UK.
Patrick A RossDepartment of Anesthesiology and Critical Care, Children's Hospital Los Angeles, 4650 Sunset Blvd Mailstop 12, Los Angeles, CA, 90027, USA.
Christopher J L NewthDepartment of Anesthesiology and Critical Care, Children's Hospital Los Angeles, 4650 Sunset Blvd Mailstop 12, Los Angeles, CA, 90027, USA.
Children's Hospital of Los Angeles · USUniversity of Southern California · USKing's College London · GBLINK (Netherlands) · NL

Funding

Minimally invasive techniques to measure upper airway obstruction in childrenK23HD075069 · NICHD · CHILDREN'S HOSPITAL OF LOS ANGELES · PI KHEMANI, ROBINDER · 2012 to 2016
$668k
NICHD NIH HHS K23 HD075069
6 · The paper itself

Abstract

purposePressure support is often used for extubation readiness testing, to overcome perceived imposed work of breathing from endotracheal tubes. We sought to determine whether effort of breathing on continuous positive airway pressure (CPAP) of 5 cmH2O is higher than post-extubation effort, and if this is confounded by endotracheal tube size or post-extubation noninvasive respiratory support.

methodsProspective trial in intubated children. Using esophageal manometry we compared effort of breathing with pressure rate product under four conditions: pressure support 10/5 cmH2O, CPAP 5 cmH2O (CPAP), and spontaneous breathing 5 and 60 min post-extubation. Subgroup analysis excluded post-extubation upper airway obstruction (UAO) and stratified by endotracheal tube size and post-extubation noninvasive respiratory support.

resultsWe included 409 children. Pressure rate product on pressure support [100 (IQR 60, 175)] was lower than CPAP [200 (120, 300)], which was lower than 5 min [300 (150, 500)] and 60 min [255 (175, 400)] post-extubation (all p < 0.01). Excluding 107 patients with post-extubation UAO (where pressure rate product after extubation is expected to be higher), pressure support still underestimated post-extubation effort by 126-147 %, and CPAP underestimated post-extubation effort by 17-25 %. For all endotracheal tube subgroups, ≤3.5 mmID (n = 152), 4-4.5 mmID (n = 102), and ≥5.0 mmID (n = 48), pressure rate product on pressure support was lower than CPAP and post-extubation (all p < 0.0001), while CPAP pressure rate product was not different from post-extubation (all p < 0.05). These findings were similar for patients extubated to noninvasive respiratory support, where pressure rate product on pressure support before extubation was significantly lower than pressure rate product post-extubation on noninvasive respiratory support (p < 0.0001, n = 81).

conclusionsRegardless of endotracheal tube size, pressure support during extubation readiness tests significantly underestimates post-extubation effort of breathing.

Indexed as

AdolescentAirway ExtubationChildChild, PreschoolContinuous Positive Airway PressureCritical CareFemaleHumansInfantInfant, NewbornIntensive Care Units, PediatricIntubation, IntratrachealMaleProspective StudiesRespiratory Function TestsRespiratory InsufficiencyAirway extubationPediatricsVentilator weaningWork of breathing

Identifiers

PMID27318942
OpenAlexW2433066197

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.