CRITERIA FOR SUCCESSFUL WEANING FROM MECHANICAL VENTILATION IN CHILDREN

Olha Filyk

doi:10.21303/2313-8416.2020.001395

Abstract

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.

Highlights

We have identified and supplemented the list of reasons for unsuccessful weaning from mechanical ventilation depending on the disorders of neurological status in children
The object of research The object of 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 and level of consciousness, presence of cough and swallowing reflexes and previous unsuccessful attempts of weaning. 1
No matter what is the etiology of this syndrome, from 30 % to 64 % of children in pediatric intensive care units (PICU) need mechanical ventilation (MV), and unsuccessful weaning might be present in 6.2 % [2] to 36 % [3, 4] of them

Summary

Introduction

No matter what is the etiology of this syndrome, from 30 % to 64 % of children in PICU need mechanical ventilation (MV), and unsuccessful weaning might be present in 6.2 % [2] to 36 % [3, 4] of them. Both the early start of weaning and its delay are harmful to patient. Extubation can lead to catastrophic circulatory or respiratory disorders, and long-term mechanical ventilation with high parameters in 29–80 % of patients is associated with atrophy and dysfunction of diaphragm [5]. Last decade represents us animal models, which illustrate how diaphragm activity during MV support can attenuate ventilator-induced diaphragmatic dysfunction [6], and human studies which confirm that length of MV is associated with the degree of diaphragm atrophy [7]

Objectives

Methods

Results

Discussion

Conclusion