Friday May 15, 2009 (pediatric pearl)
Weaning and Extubation in Children: Some Facts

Over 50% of ventilated PICU patients will have been extubated by 48 hrs after admission, but the rest often require prolonged ventilatory support. Failed planned extubations in the latter group average 8.0% but range up to 20% in some studies. Conversely, 50% of unplanned extubations end in success, implying that some patients could be extubated earlier.

Not all patients require gradual weaning. Both adult and pediatric studies have shown that when patients pass a SBT and are subjected to an ERT, 50%–75% of the patients are deemed ready to extubate.

* There are no infallible predictive tests for successful extubation. The RSBI has become moderately popular but since there is a wide range of age groups with different respiratory rates it may not be a good predictor of extubation success or failure in the pediatric population. Whether age-specific f/VT ratio is better is currently unknown.

* Adult studies show that T-piece or PS trials for an ERT are equally effective; IMV or SIMV are not deemed as useful. Pediatric studies have led to similar conclusions.

* Use of a weaning protocol results in faster weaning in adults. Although the data are less clear in children, it is likely a consistent approach to ventilator weaning will shorten ventilator time and result in better outcomes.

* A recent Cochrane Review on the role of steroids concludes : “Using corticosteroids to prevent (or treat) stridor after extubation has not proven effective for neonates, children or adults. However, given the consistent trend toward benefit, this intervention does merit further study”


Reference: click to get abstract

Weaning and extubation readiness in pediatric patients - Pediatric Critical Care Medicine. 10(1):1-11, January 2009