Context Ventilator management protocols shorten the time required to wean adult
patients from mechanical ventilation. The efficacy of such weaning protocols
among children has not been studied.
Objective To evaluate whether weaning protocols are superior to standard care
(no defined protocol) for infants and children with acute illnesses requiring
mechanical ventilator support and whether a volume support weaning protocol
using continuous automated adjustment of pressure support by the ventilator
(ie, VSV) is superior to manual adjustment of pressure support by clinicians
Design and Setting Randomized controlled trial conducted in the pediatric intensive care
units of 10 children's hospitals across North America from November 1999 through
Patients One hundred eighty-two spontaneously breathing children (<18 years
old) who had been receiving ventilator support for more than 24 hours and
who failed a test for extubation readiness on minimal pressure support.
Interventions Patients were randomized to a PSV protocol (n = 62), VSV protocol (n
= 60), or no protocol (n = 60).
Main Outcome Measures Duration of weaning time (from randomization to successful extubation);
extubation failure (any invasive or noninvasive ventilator support within
48 hours of extubation).
Results Extubation failure rates were not significantly different for PSV (15%),
VSV (24%), and no protocol (17%) (P = .44). Among
weaning successes, median duration of weaning was not significantly different
for PSV (1.6 days), VSV (1.8 days), and no protocol (2.0 days) (P = .75). Male children more frequently failed extubation (odds ratio,
7.86; 95% confidence interval, 2.36-26.2; P<.001).
Increased sedative use in the first 24 hours of weaning predicted extubation
failure (P = .04) and, among extubation successes,
duration of weaning (P<.001).
Conclusions In contrast with adult patients, the majority of children are weaned
from mechanical ventilator support in 2 days or less. Weaning protocols did
not significantly shorten this brief duration of weaning.