Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial.
BACKGROUND
Ventilator management protocols shorten the time required to wean adult patients from mechanical ventilation. The efficacy of such weaning protocols among children has not been studied.


OBJECTIVE
To evaluate whether weaning protocols are superior to standard care (no defined protocol) for infants and children with acute illnesses requiring mechanical ventilator support and whether a volume support weaning protocol using continuous automated adjustment of pressure support by the ventilator (ie, VSV) is superior to manual adjustment of pressure support by clinicians (ie, PSV).


METHODS
Randomized controlled trial conducted in the pediatric intensive care units of 10 children's hospitals across North America from November 1999 through April 2001.


METHODS
One hundred eighty-two spontaneously breathing children (<18 years old) who had been receiving ventilator support for more than 24 hours and who failed a test for extubation readiness on minimal pressure support.


METHODS
Patients were randomized to a PSV protocol (n = 62), VSV protocol (n = 60), or no protocol (n = 60).


METHODS
Duration of weaning time (from randomization to successful extubation); extubation failure (any invasive or noninvasive ventilator support within 48 hours of extubation).


RESULTS
Extubation failure rates were not significantly different for PSV (15%), VSV (24%), and no protocol (17%) (P =.44). Among weaning successes, median duration of weaning was not significantly different for PSV (1.6 days), VSV (1.8 days), and no protocol (2.0 days) (P =.75). Male children more frequently failed extubation (odds ratio, 7.86; 95% confidence interval, 2.36-26.2; P<.001). Increased sedative use in the first 24 hours of weaning predicted extubation failure (P =.04) and, among extubation successes, duration of weaning (P<.001).


CONCLUSIONS
In contrast with adult patients, the majority of children are weaned from mechanical ventilator support in 2 days or less. Weaning protocols did not significantly shorten this brief duration of weaning.
Randolph
Adrienne G
AG
Children's Hospital, MICU, FA-108, 300 Longwood Ave, Boston, MA 02115, USA. adrienne.randolph@tch.harvard.edu
Wypij
David
D
Venkataraman
Shekhar T
ST
Hanson
James H
JH
Gedeit
Rainer G
RG
Meert
Kathleen L
KL
Luckett
Peter M
PM
Forbes
Peter
P
Lilley
Michelle
M
Thompson
John
J
Cheifetz
Ira M
IM
Hibberd
Patricia
P
Wetzel
Randall
R
Cox
Peter N
PN
Arnold
John H
JH
D000293:Adolescent; D001331:Automation; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000592:standards; D012122:Ventilators, Mechanical
D006993:Hypnotics and Sedatives