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Weaning from mechanical ventilation post congenital cardiac surgery is often challenging. It is well known that not all patients can be early extubated, although most are suitable for early postoperative weaning and extubating despite complex operative procedures. With advances in anaesthesia management, cardiopulmonary bypass (CPB), and surgical techniques, the trend of 'fast tracking', and early extubating of pediatrics postcardiac surgery seems to be feasible. Unnecessary prolonged mechanical ventilation increases the complication risks as airway trauma, ventilator associated pneumonia, and increased hospital stay
Different methods have been used to predict the optimum time to make the weaning decision. These methods include, success of spontaneous breathing trials (SBTs), counting respiratory rate, observation of work of breathing, and many other calculated indices such as hypoxic index, oxygenation index, stress index, oxygen reserve index, dynamic compliance, and rapid shallow breathing index (RSBI). However, some of these indices may be misleading and not precise.
Pressure support ventilation (PSV) has been widely used in the performance of a spontaneous breathing trial because it can compensate to some extent for the additional work of breathing imposed by the endotracheal tube and the breathing circuit. However, it is difficult to recognize the exact pressure support to overcome the tubing resistance during the weaning process till extubating.
The ventilator modality of automatic tube compensation (ATC) can provide variable pressure supports during the weaning process to overcome any change in the resistance of the breathing circuit, endotracheal tube, and airways. ATC is effective in overcoming the work of breathing caused by airway resistance to allow successful weaning process and extubating.
Several studies have investigated the effectiveness of ATC and PS for ventilatory weaning in adult patients, with conflicting results. Fewer studies have focused on the pediatric population, and even fewer have specifically examined patients who have undergone cardiac surgery. Therefore, there is a need for further research to determine the most effective weaning mode for this patient population.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group P: weaning using pressure support ventilation mode | Active Comparator | Group P: Weaning trial will be done for patients using PSV 8 cmH2O without ATC. |
|
| group A:Autmated tube compensation mode | Experimental | Group A: Weaning trial will be done for patients using PSV 0 cmH2O with 100% automatic tube compensation (ATC). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| group P:pressure support ventilation mode | Procedure | Group P: Weaning trial will be done for patients using PSV 8 cmH2O without ATC |
|
| Measure | Description | Time Frame |
|---|---|---|
| work of breathing (WOB) | compare the efficacy of ATC versus PS as a modality for ventilatory weaning of pediatric postcardiac surgery as regards effects on work of breathing, (WOB) (∆ V × flow × R + Volume/compliance) (J/L/Kg). | during weaning trial 30 minutes |
| lung compliance | to compare the efficacy of ATC versus PS as a modality for ventilatory weaning of pediatric postcardiac surgery as regards effects on lung compliance. Dynamic compliance (Cdyn) (ml/cmH2O/kg). | during ventilatory weaning in 30 minutes |
| alveolar recruitment | by Ultrasound lung aeration score: assessment of the lung atelectasis by the lung ultrasound examination, six basic regions will be assessed for each lung. Each hemithorax is divided into anterior, lateral and posterior regions by the anterior and posterior axillary lines. The regions are further subdivided into upper and lower areas. Characteristics Points Normal aeration or less than 2 isolated B lines 0 Moderate loss of aeration with multiple, well-defined B-lines 1 Severe loss of aeration with multiple coalescent B-lines 2 Lung consolidation 3 | base line immediately before starting weaning trial, every 15 minutes during the weaning trial and 15 minutes after extubating |
| Measure | Description | Time Frame |
|---|---|---|
| Numbers of weaning trials. | 48 hour post operative | |
| recording the requirement for reintubation and mechanical ventilation | Requirement for reintubation and mechanical ventilation after prior successful weaning from ventilation, |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| ISLAM MOHAMMED ELBARDAN, MD | Contact | 0020 1112278083 | Islam.elbardan@Alexmed.edu.eg |
| Name | Affiliation | Role |
|---|---|---|
| LECTURER OF ANESTHESIA AND SURGICAL INTENSIVE CARE, Dr | University of Alexandria | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of medicine ,Alexandria university | Alexandria | 21521 | Egypt |
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| ID | Term |
|---|---|
| D006330 | Heart Defects, Congenital |
| ID | Term |
|---|---|
| D018376 | Cardiovascular Abnormalities |
| D002318 | Cardiovascular Diseases |
| D006331 | Heart Diseases |
| D000013 | Congenital Abnormalities |
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| group A:automatic tube compensation (ATC). | Procedure | Group A: Weaning trial will be done for patients using PSV 0 cmH2O with 100% automatic tube compensation (ATC). |
|
| within 48 hours after extubation |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |