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Factors associated with weaning success from prolonged mechanical ventilation in surviving Chinese pediatric
Tian Li1, Zhengzheng Zhang2, Hong Ren3
1Department of Pediatric Intensive Care Unit, National Children's Medical Center for South Central Region, Guangzhou Women and Children's Medical Center, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Insights
In Chinese Pediatric Intensive Care Units, higher oxygen levels at diagnosis predict weaning failure in prolonged mechanical ventilation (PMV) patients. Lower airway diseases improve weaning success.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Mechanical Ventilation
Background:
- Prolonged mechanical ventilation (PMV) presents significant weaning challenges in pediatric intensive care units (PICUs).
- Understanding ventilation strategies is crucial for improving weaning success in critically ill children.
Purpose of the Study:
- To identify factors of ventilation strategies associated with successful weaning for surviving patients with prolonged mechanical ventilation (PMV) in Pediatric Intensive Care Units (PICUs).
Main Methods:
- A retrospective study was conducted across eleven PICUs in mainland China from January 1, 2021, to December 31, 2022.
- Data from 234 patients diagnosed with PMV were analyzed to assess weaning outcomes and associated ventilation strategies.
Main Results:
- 58.1% of patients were successfully weaned; 32.1% continued mechanical ventilation.
- Pressure control was the most common initial ventilation mode, followed by synchronized intermittent mandatory ventilation (SIMV) and pressure support ventilation (PSV).
- Higher fraction of inspired oxygen (FiO2) at PMV diagnosis was linked to weaning failure (OR=0.674), while lower airway diseases improved success (OR=2.144).
Conclusions:
- Ventilation strategies for PMV weaning in Chinese PICUs are varied, with initial use of pressure control, followed by SIMV and PSV.
- Elevated FiO2 at PMV diagnosis is a risk factor for weaning failure.
- Lower airway diseases are associated with a higher likelihood of successful weaning.
Objective:
To describe factors of ventilation strategies associated with weaning success for surviving patients from prolonged mechanical ventilation (PMV) in Pediatric Intensive Care Units (PICUs).
Methods:
Conducted a retrospective study across eleven PICUs in mainland China from January 1, 2021, to December 31, 2022.
Results:
234 patients diagnosed with PMV were included in the study. Weaning Outcomes: 58.1% (136 patients) successfully weaned, includeing 11.1% (26 patients) required only a tracheostomy. 9.8% (23 patients) needed non-invasive ventilation. 32. 1% (75 patients) continued to require mechanical ventilation. 34.2% (80 patients) on invasive pressure control mode at PMV diagnosis. Pressure control was the most commonly used method. Synchronized intermittent mandatory ventilation (SIMV) used by 30.4% (71 patients). Pressure support ventilation (PSV) used by 5. 1% (12 patients). 63.2% (148 patients) received physiotherapy. 44.9% (105 patients) received cough augmentation techniques. 26.9% (63 patients) underwent tracheostomy after an average of 29 days of invasive mechanical ventilation. Higher fraction of inspired oxygen (FiO2) on PMV diagnosis day associated with weaning failure, the OR value is 0.674. While lower airway diseases had one more times chance of weaning seccess than central nervous system diseases, the OR value is 2.144.
Conclusion:
Among survivors, ventilation strategies for PMV weaning in Chinese PICUs are diverse, with pressure control commonly used initially, followed by SIMV and PSV. We identified a higher FiO2 at PMV diagnosis as risk factors for weaning failure, while lower airway diseases were easier to wean.
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