Weaning and extubation readiness in pediatric patients.
OBJECTIVE
A systematic review of weaning and extubation for pediatric patients on mechanical ventilation.


METHODS
Pediatric and adult literature, English language.


METHODS
Invited review.


METHODS
Literature review using National Library of Medicine PubMed from January 1972 until April 2008, earlier cross-referenced article citations, the Cochrane Database of Systematic Reviews, and the Internet.


CONCLUSIONS
Despite the importance of minimizing time on mechanical ventilation, only limited guidance on weaning and extubation is available from the pediatric literature. A significant proportion of patients being evaluated for weaning are actually ready for extubation, suggesting that weaning is often not considered early enough in the course of ventilation. Indications for extubation are even less clear, although a trial of spontaneous breathing would seem a prerequisite. Several indices have been developed in an attempt to predict weaning and extubation success but the available literature would suggest they offer no improvement over clinical judgment. Extubation failure rates range from 2% to 20% and bear little relationship to the duration of mechanical ventilation. Upper airway obstruction is the single most common cause of extubation failure. A reliable method of assessing readiness for weaning and predicting extubation success is not evident from the pediatric literature.
Newth
Christopher J L
CJ
Children's Hospital Los Angeles (CJLN), Los Angeles, CA, USA. cnewth@chla.usc.edu
Venkataraman
Shekhar
S
Willson
Douglas F
DF
Meert
Kathleen L
KL
Harrison
Rick
R
Dean
J Michael
JM
Pollack
Murray
M
Zimmerman
Jerry
J
Anand
Kanwaljeet J S
KJ
Carcillo
Joseph A
JA
Nicholson
Carol E
CE
D001784:Blood Gas Analysis; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000628:therapy*; D015656:Respiratory Mechanics; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods*