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Oxygen and ventilator weaning during inpatient pediatric pulmonary rehabilitation
Virginia S Kharasch1, Stephen M Haley, Helene M Dumas
1Pediatric Pulmonology Department, Franciscan Children's Hospital and Rehabilitation Center, Boston, Massachusetts 02135, USA.
Insights
Successful weaning from oxygen and ventilators is challenging for infants and young children in inpatient pulmonary programs. Prematurity was a key factor in successful ventilator weaning, though overall rates remain low.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Rehabilitation Medicine
Background:
- Limited data exists on oxygen and ventilator weaning success rates in pediatric inpatient pulmonary programs.
- Infants and young children often require prolonged respiratory support, necessitating effective weaning strategies.
Purpose of the Study:
- To determine the rates of successful oxygen and ventilator weaning in infants and young children.
- To identify factors predicting successful ventilator weaning in these patients.
Main Methods:
- Retrospective review of 34 infants and toddlers (67 admission-discharge episodes) in an inpatient pulmonary program.
- Analysis of diagnostic conditions (prematurity vs. congenital anomalies/neuromuscular disease), age, and comorbidities.
- Logistic regression modeling to identify predictors of successful ventilator weaning.
Main Results:
- Successful oxygen weaning occurred in 24% of episodes; successful ventilator weaning in 30%.
- Diagnostic condition was the primary predictor of successful ventilator weaning.
- Age at admission and comorbidities slightly improved prediction accuracy (86% overall).
- Negative predictive value for non-weaning was high (88.9%), positive predictive value for weaning was 73.3%.
Conclusions:
- Inpatient pulmonary rehabilitation shows modest success in weaning infants and young children from respiratory support.
- Children with prematurity demonstrated a higher likelihood of successful ventilator weaning.
- Predicting successful weaning remains challenging, with higher accuracy in identifying episodes where weaning will not occur.
Abstract:
Rates of oxygen and ventilator weaning, and factors related to successful weaning in inpatient pediatric pulmonary programs for infants and young children, have not been frequently reported in the literature. A retrospective review was conducted of 34 infants and toddlers with either a diagnostic condition of prematurity (PM) or congenital anomalies/neuromuscular disease (CA/NM) discharged from an inpatient pulmonary program. These cases represent 67 hospital admission-discharge episodes over a 6-year period. The rate of successful oxygen weaning (decrease to 0 hr per day) and ventilator weaning (decrease to <12 hr per day) and predictive factors related to successful ventilator weaning per admission-discharge episode were examined. Successful oxygen weaning was achieved during 24% and successful ventilator weaning was achieved during 30% of the admission-discharge episodes. No significant relationships were found between the selected demographic and clinical factors and oxygen weaning. Using a logistic regression model, the major variable associated with successful ventilator weaning per admission-discharge episode was diagnostic condition. Age at admission and the presence of comorbidities added slightly to the prediction model. The overall model yielded 86% accuracy for predicting a decrease in ventilator hours. However, projecting in which episodes children will not be weaned (negative predictive value = 88.9%) was more accurate than projecting in which episodes children will be weaned (positive predictive value = 73.3%). Although the program achieved a relatively low rate of successful ventilator weaning, children with a diagnostic condition of prematurity were more likely to be successfully weaned during inpatient pulmonary rehabilitation.