title: Oxygen and ventilator weaning during inpatient pediatric pulmonary rehabilitation.
abstract: Rates of oxygen and ventilator weaning, and factors related to successful weaning in inpatient pediatric pulmonary programs for infants and young children, have not been frequently reported in the literature. A retrospective review was conducted of 34 infants and toddlers with either a diagnostic condition of prematurity (PM) or congenital anomalies/neuromuscular disease (CA/NM) discharged from an inpatient pulmonary program. These cases represent 67 hospital admission-discharge episodes over a 6-year period. The rate of successful oxygen weaning (decrease to 0 hr per day) and ventilator weaning (decrease to <12 hr per day) and predictive factors related to successful ventilator weaning per admission-discharge episode were examined. Successful oxygen weaning was achieved during 24% and successful ventilator weaning was achieved during 30% of the admission-discharge episodes. No significant relationships were found between the selected demographic and clinical factors and oxygen weaning. Using a logistic regression model, the major variable associated with successful ventilator weaning per admission-discharge episode was diagnostic condition. Age at admission and the presence of comorbidities added slightly to the prediction model. The overall model yielded 86% accuracy for predicting a decrease in ventilator hours. However, projecting in which episodes children will not be weaned (negative predictive value = 88.9%) was more accurate than projecting in which episodes children will be weaned (positive predictive value = 73.3%). Although the program achieved a relatively low rate of successful ventilator weaning, children with a diagnostic condition of prematurity were more likely to be successfully weaned during inpatient pulmonary rehabilitation.
authors.affiliation: Pediatric Pulmonology Department, Franciscan Children's Hospital and Rehabilitation Center, Boston, Massachusetts 02135, USA.
authors.forename: Virginia S
authors.initials: VS
authors.lastname: Kharasch
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Haley
authors.forename: Helene M
authors.initials: HM
authors.lastname: Dumas
authors.forename: Larry H
authors.initials: LH
authors.lastname: Ludlow
authors.forename: Jane E
authors.initials: JE
authors.lastname: O'Brien
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000628:therapy; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy; D016015:Logistic Models; D008297:Male; D010102:Oxygen Inhalation Therapy; D011237:Predictive Value of Tests; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D015300:Ventilator Weaning