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Decreasing mechanical ventilator support in medically fragile children with bronchopulmonary dysplasia: A

Swetha Suresh1,2,3, Heather G Huxol1,4, Ronald L Morton1

  • 1Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.

Journal of Pediatric Rehabilitation Medicine
|September 28, 2015
PubMed

Insights

A new 5-step protocol for weaning medically fragile children from prolonged mechanical ventilation (PMV) in pediatric long-term extended care facilities (P-LTEC) was developed. This standardized approach aims to improve weaning effectiveness and reduce associated risks.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory therapy
  • Long-term care

Background:

  • Prolonged mechanical ventilation (PMV) is common in medically fragile children within pediatric long-term extended care facilities (P-LTEC).
  • Current PMV weaning practices are unstandardized, leading to potential complications like delayed weaning, infections, increased mortality, and placement difficulties.
  • A systematic approach is needed to optimize PMV weaning in this vulnerable population.

Purpose of the Study:

  • To develop and evaluate a standardized, step-wise protocol for weaning children from prolonged mechanical ventilation in P-LTEC settings.
  • To address the current lack of a standardized weaning process and its associated negative outcomes.

Main Methods:

  • Retrospective chart review of five tracheostomized children with bronchopulmonary dysplasia undergoing PMV.
  • Development of a 5-step weaning protocol based on retrospective data analysis.
  • The protocol involved gradual reduction of ventilator support, including pressure control, fraction of inspired oxygen, and pressure support, followed by trials of continuous positive airway pressure (CPAP) and tracheostomy collar (TC).

Main Results:

  • A 5-step weaning protocol was successfully created.
  • Advancing to Step 2 (CPAP trial while awake) took the longest mean duration (31.2 months), potentially due to episodic illnesses.
  • Subsequent steps showed shorter mean durations: 3.2 months to Step 3, 1.6 months to Step 4, and 2.6 months to Step 5 (TC for 24 hours).

Conclusions:

  • The developed 5-step protocol provides a structured framework for weaning children from PMV in P-LTEC facilities.
  • This standardized approach offers reasonable expectations for successful PMV weaning.
  • Implementation of this protocol could improve patient outcomes and streamline the weaning process.
Abstract

Keywords:
Mechanical ventilationbronchopulmonary dysplasiamedically fragile childrenpediatric long term extended care facilitiesweaning

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