Weaning nocturnal ventilation and decannulation in a pediatric ventilator care program

Area of Science:

• Pediatric Pulmonology
• Critical Care Medicine
• Quality Improvement

Background:

• Children with chronic respiratory failure often require tracheostomy and mechanical ventilation.
• Many of these children can eventually be weaned from ventilation and decannulated.

Purpose of the Study:

• To evaluate the safety and success of ventilator weaning and decannulation in children.
• To assess the utility of end-tidal carbon dioxide (ETCO2) monitoring during these processes.

Main Methods:

• A chart review of patients undergoing evaluation for nocturnal ventilation (NV) weaning or decannulation from 2007-2014.
• Collection of patient demographics, monitoring techniques, and outcomes.
• Implementation and comparison of ETCO2 monitoring with arterial blood gas (pCO2).

Main Results:

• Nocturnal ventilation weaning was successful in 20/21 patients; decannulation in 18/21 attempts.
• ETCO2 monitoring was performed in 12 attempts (29%) and correlated with pCO2 (R²=0.53, P<0.02).
• Clinical signs of respiratory distress, not monitoring results, primarily guided decision-making.

Conclusions:

• Inpatient observation for NV weaning and decannulation is safe and effective.
• Home-based NV weaning may also be safe with close monitoring.
• ETCO2 monitoring can provide reassurance but rarely influences clinical decisions.
• An algorithm for NV weaning and decannulation is proposed based on clinical experience.