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Mechanical Ventilation Boot Camp Curriculum
Published on: March 12, 2018
Outcomes of mechanical ventilation according to WIND classification in pediatric patients
Ah Young Choi1, Minji Kim2, Esther Park1
1Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Insights
The new Weaning according to a New Definition (WIND) classification effectively predicts intensive care unit mortality in pediatric patients. This new classification system shows a strong association with patient outcomes, highlighting its clinical utility.
Area of Science:
- Pediatric critical care medicine
- Respiratory therapy
- Clinical outcomes research
Background:
- Outcomes of pediatric mechanical ventilation weaning are poorly understood.
- Existing classification systems for weaning have limited applicability.
- The Weaning according to a New Definition (WIND) classification was developed to address these limitations.
Purpose of the Study:
- To evaluate the relationship between the new WIND classification and patient outcomes in a pediatric intensive care unit (ICU).
- To assess the predictive value of the WIND classification for mortality in pediatric patients undergoing mechanical ventilation.
Main Methods:
- Retrospective cohort study in a tertiary pediatric ICU.
- Inclusion of patients under 18 years receiving invasive mechanical ventilation >24 hours.
- Classification of weaning processes into four groups based on duration after the first separation attempt (SA): no-SA, short (<24h), difficult (24h-7d), and prolonged (>7d).
Main Results:
- The mortality rate was significantly higher in the prolonged weaning group (17.9%) and the no-SA group (93.2%) compared to short and difficult weaning groups (0%).
- Admission severity and underlying oncologic disease were identified as independent risk factors for lack of separation attempt.
- Spontaneous breathing tests were performed in 70.1% of patients.
Conclusions:
- The WIND classification is significantly associated with ICU mortality in pediatric patients.
- This classification system demonstrates potential for improving clinical outcomes and guiding weaning protocols.
- Further research is warranted to validate and refine the application of the WIND classification.
Background:
The outcomes of weaning processes are not well known in pediatric patients, and the International Conference Classification on weaning from mechanical ventilation showed limited application. We evaluate the relationship between the new Weaning according to a New Definition (WIND) classification and outcome in pediatric patients.
Methods:
We conducted a retrospective cohort study in a tertiary pediatric intensive care unit (ICU). We included patients under 18 years of age who received invasive mechanical ventilation for more than 24 h and excluded cases with other than the first ICU admissions, tracheostomy with home ventilation before admission, intubation or weaning processes conducted in other ICU, and weaning with extracorporeal membrane oxygenation. Weaning processes were classified into four groups according to weaning duration after the first separation attempt (SA): no-SA, short weaning (< 24 h), difficult weaning (24 h-7 days), and prolonged weaning (> 7 days). Mortality rates were compared across groups using the Kruskal-Wallis test, and risk factors for the no-SA group were analyzed by multivariate logistic regression tests with age, sex, severity score at admission, admission type, and underlying disease as variables.
Results:
Among 313 patients, 224 were enrolled and had a median age of 2.1 (interquartile range 0.5-6.6) years. Spontaneous breathing tests were done in 70.1% of enrolled patients. The median duration of intubation to the first SA was 4 (range 0-36) days, and 92.8% patients underwent the first SA within 14 days. The mortality rate was 0% in the short (0/99) and difficult (0/53) weaning groups and 17.9% (5/28) in the prolonged weaning group (p < 0.001). The mortality rate of the no-SA group was 93.2% (41/44). Admission severity (hazard ratio 1.036, confidence interval 1.022-1.050) and underlying oncologic disease (hazard ratio 7.341, confidence interval 3.008-17.916) were independent risk factors for lack of SA.
Conclusions:
In conclusion, WIND classification is associated with ICU mortality in pediatric patients. Further studies of this association are required to improve protocols associated with the weaning process and clinical outcomes. Trial registration Retrospectively registered.
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