Abstract
BackgroundThe outcomes of weaning processes are not well known in pediatric patients, and the International Conference Classification on weaning from mechanical ventilation showed limited application. We evaluate the relationship between the new Weaning according to a New Definition (WIND) classification and outcome in pediatric patients.MethodsWe conducted a retrospective cohort study in a tertiary pediatric intensive care unit (ICU). We included patients under 18 years of age who received invasive mechanical ventilation for more than 24 h and excluded cases with other than the first ICU admissions, tracheostomy with home ventilation before admission, intubation or weaning processes conducted in other ICU, and weaning with extracorporeal membrane oxygenation. Weaning processes were classified into four groups according to weaning duration after the first separation attempt (SA): no-SA, short weaning (< 24 h), difficult weaning (24 h–7 days), and prolonged weaning (> 7 days). Mortality rates were compared across groups using the Kruskal–Wallis test, and risk factors for the no-SA group were analyzed by multivariate logistic regression tests with age, sex, severity score at admission, admission type, and underlying disease as variables.ResultsAmong 313 patients, 224 were enrolled and had a median age of 2.1 (interquartile range 0.5–6.6) years. Spontaneous breathing tests were done in 70.1% of enrolled patients. The median duration of intubation to the first SA was 4 (range 0–36) days, and 92.8% patients underwent the first SA within 14 days. The mortality rate was 0% in the short (0/99) and difficult (0/53) weaning groups and 17.9% (5/28) in the prolonged weaning group (p < 0.001). The mortality rate of the no-SA group was 93.2% (41/44). Admission severity (hazard ratio 1.036, confidence interval 1.022–1.050) and underlying oncologic disease (hazard ratio 7.341, confidence interval 3.008–17.916) were independent risk factors for lack of SA.ConclusionsIn conclusion, WIND classification is associated with ICU mortality in pediatric patients. Further studies of this association are required to improve protocols associated with the weaning process and clinical outcomes.Trial registration Retrospectively registered.
Highlights
The outcomes of weaning processes are not well known in pediatric patients, and the International Conference Classification on weaning from mechanical ventilation showed limited application
The weaning process was classified by the International Consensus Conference on weaning from Mechanical ventilation (MV) according to difficulty and duration of the weaning process: simple weaning, difficult weaning, and prolonged weaning [7]
The International Consensus Conference classification excludes patients who were not weaned from MV or who were weaned from MV without a spontaneous breathing test (SBT)
Summary
The outcomes of weaning processes are not well known in pediatric patients, and the International Conference Classification on weaning from mechanical ventilation showed limited application. We evaluate the relationship between the new Weaning according to a New Definition (WIND) classification and outcome in pediatric patients. The weaning process was classified by the International Consensus Conference on weaning from MV according to difficulty and duration of the weaning process: simple weaning, difficult weaning, and prolonged weaning [7]. The International Consensus Conference classification excludes patients who were not weaned from MV or who were weaned from MV without a spontaneous breathing test (SBT). In 2017, a new pragmatic classification of weaning, the Weaning according to a New Definition (WIND) classification, was proposed to overcome these limitations and was associated with survival to discharge in adult ICU patients [12]
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