Weaning from ventilation in paediatric intensive care: an intervention study.
OBJECTIVE
To standardise the paediatric intensive care unit (PICU) team's approach to weaning paediatric patients from mechanical ventilation.


METHODS
The study employed a time series design over 2 years. A total of 220 patients (pre-intervention n=107 and post-intervention n=113) were studied. Independent variables measured in both the pre- and post-intervention groups included total ventilation time (TVT), weaning duration (WD), and length of stay (LOS), as well as quality indicators (weaning failure and reintubation rates).


RESULTS
The pre-intervention analysis demonstrated an existing fluctuation between outcome variables. When outcome indicators were compared between the pre- and post-intervention groups, both TVT and LOS were longer post-intervention (median difference: TVT -15.8 hours, P<0.068; and LOS -23.75 hours, P<0.088). WD was comparable between groups (median difference: WD -1.5 hours, P<0.427). Quality indicators were better post-intervention. Kaplan-Meier survival analysis demonstrated that long-term ventilated patients post-intervention had a reduced probability of remaining ventilated.


CONCLUSIONS
Weaning children from mechanical ventilation can be performed safely and effectively with the aid of collaborative guidelines. Although times were prolonged, the quality indicators were slightly improved, indicating that quicker was not always better. Long-term ventilated patients, in particular, would appear to benefit from weaning guidelines.
Keogh
Samantha
S
School of Nursing, Queensland University of Technology, Royal Children's Hospital, Level 5, Woolworth's Building Herston Road, Brisbane, Queensland 4029, Australia. Samantha.Keogh@health.qld.gov.au
Courtney
Mary
M
Coyer
Fiona
F
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D017410:Practice Guidelines as Topic; D015300:Ventilator Weaning / Q000379:methods / Q000451:nursing*