Weaning and Extubation in Pediatrics

Cintia      Johnston; Paulo      Sergio Lucas da Silva

Abstract

Mechanical ventilation is a life-supporting intervention that is used for a significant number of patients in ICUs. The current pediatric literature shows that the science of ventilator weaning and extubation remains undetermined. No optimal weaning method has been described for a more rapid and successful extubation. Protocol-based approaches to weaning may have potential benefits in advancing readiness to extubation, but no significant outcome differences have been found to date. The analysis of clinical markers of extubation success has not revealed any specific physiologic predictor of extubation success in children. However, a daily trial of readiness to extubate is the most effective technique to determine likelihood of success. Extubation failure rates range from 16% to 20% and bear little relation to the duration of mechanical ventilation. Upper airway obstruction is the primary cause of extubation failure in most pediatric studies. Therefore, efforts to decrease airway edema before extubation should be considered. Corticosteroids seem to be beneficial for infants and children, but definitive evidence of their efficacy is lacking.

Keywords: Extubation, mechanical ventilation, respiratory support, weaning, pediatrics, maximal expiratory pressure, rapid shallow breathing index, respiratory muscle load, hyperthermia, Spontaneous Breathing Trial