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Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized

Adrienne G Randolph1, David Wypij, Shekhar T Venkataraman

  • 1Children's Hospital, MICU, FA-108, 300 Longwood Ave, Boston, MA 02115, USA. adrienne.randolph@tch.harvard.edu

JAMA
|November 28, 2002
PubMed

Insights

Pediatric ventilator weaning protocols did not significantly shorten the time to extubate children. Standard care is as effective as pressure support ventilation (PSV) or volume support ventilation (VSV) protocols for pediatric mechanical ventilation weaning.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory therapy

Background:

  • Ventilator management protocols are proven to expedite weaning in adults.
  • Efficacy of these protocols in pediatric populations remains understudied.

Purpose of the Study:

  • To compare weaning protocols versus standard care in pediatric mechanical ventilation.
  • To assess if volume support ventilation (VSV) is superior to pressure support ventilation (PSV) for weaning.

Main Methods:

  • A randomized controlled trial in 10 North American pediatric intensive care units.
  • 182 children (<18 years) receiving mechanical ventilation for >24 hours were randomized.
  • Groups included PSV protocol, VSV protocol, and no protocol.

Main Results:

  • No significant difference in extubation failure rates among PSV (15%), VSV (24%), and no protocol (17%) groups.
  • Median weaning duration was similar across groups: PSV (1.6 days), VSV (1.8 days), no protocol (2.0 days).
  • Male sex and increased sedative use predicted extubation failure and prolonged weaning time.

Conclusions:

  • Most children are weaned from mechanical ventilation within 2 days.
  • Weaning protocols did not significantly reduce weaning duration in this pediatric cohort.
  • Findings contrast with adult studies, suggesting different weaning dynamics in children.
Abstract

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