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Lung India. 2017 Mar-Apr; 34(2): 216–217.
PMCID: PMC5351377

Mapleson D continuous positive airway pressure system for weaning of mechanical ventilation in pediatric patients: In response


We are writing in response to the letter from Dr. Mandal et al.[1] regarding our article entitled “Mapleson D continuous positive airway pressure (CPAP) system for weaning of mechanical ventilation (MV) in pediatric patients.” We would also like to thank Dr. Mandal et al. for their kind remarks about our article and offer you the following responses. First of all, regarding first point of their letter, we would like to clarify that all infants and children who received prolonged MV for more than 24 h during a period of 4 years were enrolled in this retrospective observational study.

Extubation failure rates range from 2% to 22%[2,3] and bear little relationship to duration of MV. We agree that our study showed a higher extubation failure (26%). Patients undergoing major surgery and general anesthesia with muscle relaxation/paralysis have an elevated incidence of intraoperative pulmonary collapse which is associated with worsening intraoperative gas exchange and in some cases, the need for prolonged postoperative respiratory support.[4] We think that our results could be due in part to the characteristics of the study population included in this research, incorporating surgical patients. We would like to clarify that this is a retrospective observational study and the purpose of this research is to show a useful and simple alternative to more complex and expensive CPAP/bilevel positive airway pressure (BiPAP) systems for weaning of MV in children. We agree with Dr. Mandal et al. that it would be interesting to compare the Mapleson D CPAP system with other CPAP/BiPAP devices in a similar situation. Adult studies show that T-piece or pressure support trials for extubation readiness test have been equally effective;[5] hence, we think further high-quality studies compared this device would be necessary.

We have to highlight that this is a retrospective observational study, and the heterogeneity of results might be related with the different clinical characteristics of the patients, different major surgical pathologies enrolled, and with limited and heterogeneous data recorded. We agree that due to the abnormal distribution of the data we should have presented these in median ± interquartile range. Indeed, the results from Table 3 regarding MV are incorrect and they should be 9/4 instead of 19/22 and 23/4 instead of 13/12. To sum up, we thank the authors about their highlight regarding differences observed comparing mean SpO2, systolic blood pressure, and diastolic blood pressure at baseline continous mandatory ventilation (CMV) and 2 h postextubation. This appreciation is interesting and could be due to different sedation level of the patients enrolled in the study in different phases and related to the discomfort of the patients during CMV phase.

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Conflicts of interest

There are no conflicts of interest.


1. Mandal A, Sahi PK. Mapleson D continuous positive airway pressure system for weaning of mechanical ventilation in pediatric patients. Lung India. 2016;34:215–6.
2. Edmunds S, Weiss I, Harrison R. Extubation failure in a large pediatric ICU population. Chest. 2001;119:897–900. [PubMed]
3. Farias JA, Alía I, Retta A, Olazarri F, Fernández A, Esteban A, et al. An evaluation of extubation failure predictors in mechanically ventilated infants and children. Intensive Care Med. 2002;28:752–7. [PubMed]
4. Brismar B, Hedenstierna G, Lundquist H, Strandberg A, Svensson L, Tokics L. Pulmonary densities during anesthesia with muscular relaxation – A proposal of atelectasis. Anesthesiology. 1985;62:422–8. [PubMed]
5. Newth CJ, Venkataraman S, Willson DF, Meert KL, Harrison R, Dean JM, et al. Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med. 2009;10:1–11. [PMC free article] [PubMed]

Articles from Lung India : Official Organ of Indian Chest Society are provided here courtesy of Wolters Kluwer -- Medknow Publications