Weaning from artificial ventilation

Abstract

When a child has recovered from the underlying disease which initially required intubation, the process of weaning from mechanical ventilation can begin, the endpoint being the removal of the endotracheal tube. Intensivists in the PICU, NICU, and CICU environment, on the whole tend to arrive at this end point by using “clinical judgement and years of experience” However, recent data from adult studies clearly show that specific weaning protocols decrease the duration of mechanical ventilation [1–3]. The criteria for determining whether the individual patient is capable of sustaining spontaneous respiration following withdrawal of respiratory support are becoming more clear. A number of specific variables have now been recommended to predict successful weaning in adults [4, 5]. Basing the decision of extubation upon clinical grounds alone can lead to problems, the incidence of reintubation and recommencing ventilation without weaning guidelines ranging between 17%–19% in adults [6] and 19%–28% in children [7] and neonates [8]. The imperative to extubate patients is determined by the higher incidence of nosocomial infection [9] and airway trauma and the associated risks of accidental extubation [10].