Published August 31, 2020 | Version v1
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CRITERIA FOR SUCCESSFUL WEANING FROM MECHANICAL VENTILATION IN CHILDREN

Creators

  • 1. Danylo Halytsky Lviv National Medical University

Description

The aim of the research was to establish criteria for successful weaning from mechanical ventilation in children based on analysis of Paediatric rapid shallow breathing index, maximum amplitude of diaphragm movements, diaphragm thickening fraction and pressure support (PS), which ensure minimal respiratory muscle load, level of consciousness which ensure minimal respiratory muscle load and presence of cough and swallowing reflexes and previous unsuccessful attempts of weaning.

Investigated problem: there is no consensus on the basic physiological parameters for successful extubation that have to be achieved during weaning from mechanical ventilation in children due to variability in size and degree of maturity of lungs and patients’ comorbidities. It leads to the lack of clinical justification for the routine practice of weaning in children.

The main scientific results: We have established a list of causes of unsuccessful weaning depending on the function of the diaphragm in children with different types of respiratory failure.

We have clarified and supplemented the list of reasons for unsuccessful weaning from mechanical ventilation depending on nutritional status and level of serum electrolytes in children.

We have identified and supplemented the list of reasons for unsuccessful weaning from mechanical ventilation depending on the disorders of neurological status in children.

We have supplemented the algorithm for predicting difficult weaning from mechanical ventilation in children.

The area of practical use of the research results: the obtained results have to increase the rate of successful weaning in children with acute respiratory failure in pediatric intensive care units.

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References

  • Burns, J. P., Sellers, D. E., Meyer, E. C., Lewis-Newby, M., Truog, R. D. (2014). Epidemiology of Death in the PICU at Five U.S. Teaching Hospitals*. Critical Care Medicine, 42 (9), 2101–2108. doi: http://doi.org/10.1097/ccm.0000000000000498
  • Dres, M., Jung, B., Molinari, N., Manna, F., Dubé, B.-P., Chanques, G. et. al. (2019). Respective contribution of intensive care unit-acquired limb muscle and severe diaphragm weakness on weaning outcome and mortality: a post hoc analysis of two cohorts. Critical Care, 23 (1). doi: http://doi.org/10.1186/s13054-019-2650-z
  • Abdo, M., Talat, M., Zamzam, S. (2014). Difficult weaning from mechanical ventilation in the pediatric ICU. Ain-Shams Journal of Anaesthesiology, 7 (1), 76–79. doi: http://doi.org/10.4103/1687-7934.128423
  • Fontela, P. S., Piva, J. P., Garcia, P. C., Bered, P. L., Zilles, K. (2005). Risk factors for extubation failure in mechanically ventilated pediatric patients. Pediatric Critical Care Medicine, 6 (2), 166–170. doi: http://doi.org/10.1097/01.pcc.0000154922.65189.48
  • Goligher, E. C., Dres, M., Fan, E., Rubenfeld, G. D., Scales, D. C., Herridge, M. S. et. al. (2018). Mechanical Ventilation–induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes. American Journal of Respiratory and Critical Care Medicine, 197 (2), 204–213. doi: http://doi.org/10.1164/rccm.201703-0536oc
  • Martin, A. D., Joseph, A.-M., Beaver, T. M., Smith, B. K., Martin, T. D., Berg, K. et. al. (2014). Effect of Intermittent Phrenic Nerve Stimulation During Cardiothoracic Surgery on Mitochondrial Respiration in the Human Diaphragm*. Critical Care Medicine, 42 (2), e152–e156. doi: http://doi.org/10.1097/ccm.0b013e3182a63fdf
  • Schepens, T., Verbrugghe, W., Dams, K., Corthouts, B., Parizel, P. M., Jorens, P. G. (2015). The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study. Critical Care, 19 (1). doi: http://doi.org/10.1186/s13054-015-1141-0
  • Johnson, R. W., Ng, K. W. P., Dietz, A. R., Hartman, M. E., Baty, J. D., Hasan, N. et. al. (2018). Muscle atrophy in mechanically-ventilated critically ill children. PLOS ONE, 13 (12), e0207720. doi: http://doi.org/10.1371/journal.pone.0207720
  • Smallwood, C. D. (2019). Spontaneous Breathing Trials in Children: Putting the "T" in SBT. Respiratory Care, 64 (5), 614–615. doi: http://doi.org/10.4187/respcare.07057
  • Kneyber, M. C. J., de Luca, D., Calderini, E., Jarreau, P.-H., Javouhey, E. et. al. (2017). Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Medicine, 43 (12), 1764–1780. doi: http://doi.org/10.1007/s00134-017-4920-z
  • Schepens, T., Dres, M., Heunks, L., Goligher, E. C. (2019). Diaphragm-protective mechanical ventilation. Current Opinion in Critical Care, 25 (1), 77–85. doi: http://doi.org/10.1097/mcc.0000000000000578
  • Schepens, T., Dianti, J. (2020). Diaphragm protection. Current Opinion in Critical Care, 26 (1), 35–40. doi: http://doi.org/10.1097/mcc.0000000000000683