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Weaning from ventilation in paediatric intensive care: an intervention study.
Samantha Keogh1, Mary Courtney, Fiona Coyer
1School of Nursing, Queensland University of Technology, Royal Children's Hospital, Level 5, Woolworth's Building Herston Road, Brisbane, Queensland 4029, Australia. Samantha.Keogh@health.qld.gov.au
Intensive & Critical Care Nursing
|August 14, 2003
Summary
Standardizing mechanical ventilation weaning in paediatric intensive care units (PICU) improved quality indicators, even with slightly longer ventilation and hospital stays. Collaborative guidelines benefit long-term ventilated children.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Clinical Quality Improvement
Background:
- Mechanical ventilation is a critical intervention for critically ill children.
- Variability in weaning protocols can impact patient outcomes.
- Standardization of the weaning process is essential for improving care quality.
Purpose of the Study:
- To standardize the paediatric intensive care unit (PICU) team's approach to weaning pediatric patients from mechanical ventilation.
- To evaluate the impact of a standardized weaning protocol on patient outcomes and quality indicators.
Main Methods:
- A time series design was employed over 2 years, studying 220 pediatric patients (107 pre-intervention, 113 post-intervention).
- Key variables measured included total ventilation time (TVT), weaning duration (WD), length of stay (LOS), weaning failure, and reintubation rates.
- Kaplan-Meier survival analysis was used to assess long-term ventilation probability.
Main Results:
- Post-intervention, total ventilation time (TVT) and length of stay (LOS) were longer (median difference: TVT -15.8 hours; LOS -23.75 hours), though not statistically significant (P<0.068, P<0.088).
- Weaning duration (WD) was comparable between groups (median difference: WD -1.5 hours, P<0.427).
- Quality indicators, including weaning failure and reintubation rates, showed improvement post-intervention. Long-term ventilated patients demonstrated a reduced probability of remaining ventilated.
Conclusions:
- Collaborative guidelines can safely and effectively standardize the weaning of children from mechanical ventilation.
- While ventilation and hospital stay durations may increase, improved quality indicators suggest that faster weaning is not always superior.
- Standardized weaning protocols appear particularly beneficial for long-term ventilated pediatric patients.