Weaning from mechanical ventilation: patterns in young children recovering from acute hypoxemic respiratory failure.
OBJECTIVE
The purpose of the study was to describe the patterns of weaning from mechanical ventilation in young children recovering from acute hypoxemic respiratory failure.


METHODS
Decision-making rules on progressive weaning were developed and applied to existing data on 82 patients 2 weeks to 6 years old in the Pediatric Acute Respiratory Distress Syndrome Data Set.


RESULTS
Three patterns of weaning progress were detected: sprint, consistent, and inconsistent. Length of ventilation and weaning progressively increased from the sprint, to the consistent, to the inconsistent subset. Patients in the inconsistent subset were most likely to have a systemic (sepsis or shock) trigger of acute respiratory distress syndrome and to be rated as having at least moderate disability at discharge. Hypothesis-generating univariate and then multivariate logistic regression analyses indicated that patients who experienced more days of mechanical ventilation before the start of weaning and who had a higher oxygenation index during the weaning process were most likely to have an inconsistent pattern of weaning.


CONCLUSIONS
Patterns of weaning are discernible in a population of young children and indicate a subset at risk for inconsistent weaning. Knowing the patterns of weaning may help clinicians anticipate, perhaps plot, and then modulate a patient's weaning trajectory.
Curley
M A
MA
Children's Hospital, Boston, Mass., USA.
Fackler
J C
JC
D000208:Acute Disease; D000704:Analysis of Variance; D015400:Clinical Nursing Research; D003289:Convalescence; D003422:Critical Care; D003661:Decision Support Techniques; D006233:Persons with Disabilities; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009730:Nursing Assessment; D010363:Pattern Recognition, Automated; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods* / Q000451:nursing*