scholarly journals CLINICAL AND PHYSIOLOGICAL JUSTIFICATION OF WEANING FROM MECHANICAL VENTILATION IN CHILDREN WITH RESPIRATORY FAILURE

2020 ◽  
pp. 34-36
Author(s):  
Olha Filyk
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Pediatric Intensive Care ◽  
Electrolyte Balance ◽  
Study Group ◽  
Weaning From Mechanical Ventilation ◽  
Results Of Treatment ◽  
Group I ◽  
Nervous System Function ◽  
Develop Strategy

Children frequently are admitted to pediatric intensive care units due to acute respiratory failure and up to 64 % of them need to be mechanically ventilated and later weaned. The aim was to develop strategy of weaning from mechanical ventilation in children with different types of respiratory failure. Materials and methods. The work was based on results of treatment of 237 patients aged from 1 month to 18 years old, who were divided into control and study group. Patients of study group were randomized into group I (83 patients) and received traditional ICU monitoring and treatment and group II (79 patients), where was used proposed by us methods of monitoring and treatment. Results. There was supplemented data on the etiology of respiratory failure in children with taking into account function of diaphragm, changes in hemodynamics, nutritional status, electrolyte balance and central nervous system function. It was established new mechanisms of inadequacy of spontaneous breathing during mechanical ventilation and found causes of unsuccessful weaning from mechanical ventilation. In addition, it was developed a weaning strategy with goal-directed therapy for disorders treatment according the type of respiratory failure and children`s age. As a result, important scientific problem was solved and the results of treatment of children with respiratory failure was improved. Conclusions. It was found that proposed strategy of weaning from mechanical ventilation allowed to reduce the duration of mechanical ventilation and the frequency of complications (reintubations). There were no significant differences in the frequency of tracheostomy among patients of I and II groups.

scholarly journals Neuromuscular dysfunction associated with delayed weaning from mechanical ventilation in patients with respiratory failure

2012 ◽  
Vol 48 (3) ◽  
pp. 223-232 ◽  
Author(s):  
Yehia Khalil ◽  
Emad El Din Mustafa ◽  
Ahmed Youssef ◽  
Mohamed Hassan Imam ◽  
Amni Fathy El Behiry
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Weaning From Mechanical Ventilation ◽  
Neuromuscular Dysfunction

Weaning from mechanical ventilation in pediatric intensive care patients

1998 ◽  
Vol 24 (10) ◽  
pp. 1070-1075 ◽  
Author(s):  
J. A. Farias ◽  
I. Alía ◽  
A. Esteban ◽  
A. N. Golubicki ◽  
F. A. Olazarri
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care ◽  
Weaning From Mechanical Ventilation ◽  
Intensive Care Patients

scholarly journals Unsuccessful weaning from mechanical ventilation in children and ways to avoid it

2020 ◽  
pp. 82-89
Author(s):  
O. V. Filyk
Keyword(s):  
Mechanical Ventilation ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Weaning From Mechanical Ventilation ◽  
Ventilation Strategy ◽  
Group I ◽  
Protective Ventilation Strategy ◽  
Elective Tracheostomy ◽  
Group Ii ◽  
Lung Protective Ventilation Strategy

The aim of the work: to determine causes of unsuccessful weaning depending on subglottic edema markers, level of sedation and sedation-agitation, changes in neurological status and bulbar disorders in children with different types of respiratory failure. Materials and Methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children's Clinical Hospital "OHMATDYT". We included 89 patients aged 1 month – 18 years with acute respiratory failure who was mechanically ventilated for more than 3 days. They were randomly divided into 2 groups. Group I included patients who received lung-protective ventilation strategy and assessment central nervous system function and the percentage of leakage of the gas mixture near the endotracheal tube; group II – patients who received diaphragm-protective in addition to lung-protective ventilation strategy and took into account the results of central nervous system assessment and respiratory gas mixture leakage near endotracheal tube during weaning from mechanical ventilation. The primary endpoint was the frequency of reintubations, the secon­dary endpoint was the frequency of complications (tracheostomy). 82 patients were included in the data analysis. Patients were divided into age subgroups: subgroup 1 – children 1 month – 1 year; subgroup – children 1–3 years; subgroup 3 – children 3–6 years; subgroup 4 – children 6–13 years; subgroup 5 – children 13–18 years. Results and Discussion. The frequency of reintubations in patients of the age subgroup 1 was reduced in group II to 5.3 % compared with 22.7 % in group I (p = 0.02), which was accompanied by a higher frequency of elective tracheostomy (before the first attempt of weaning from mechanical ventilation) which was 11 % in comparison with 0 %, p = 0.001). The frequency of reintubations in the age subgroup 2 was reduced to 5.9 % in group II vs 20 % in group I (p = 0.04), and elective tracheostomy was performed in 18 % patients in group II vs 5 % patients in group I (p = 0.05). There were no significant differences in the frequency of reintubations among patients in the age subgroup 3 (14.2 % in group I vs 11.1 % in group II, p = 0.31); in the age subgroup 4 (13 % vs 17 %, p = 0.19); the age subgroup 5 (6 % vs 7 %, p = 0.72).

Weaning from mechanical ventilation: patterns in young children recovering from acute hypoxemic respiratory failure

1998 ◽  
Vol 7 (5) ◽  
pp. 335-345 ◽  
Author(s):  
MA Curley ◽  
JC Fackler
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Young Children ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Weaning From Mechanical Ventilation ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

OBJECTIVE: The purpose of the study was to describe the patterns of weaning from mechanical ventilation in young children recovering from acute hypoxemic respiratory failure. METHODS: Decision-making rules on progressive weaning were developed and applied to existing data on 82 patients 2 weeks to 6 years old in the Pediatric Acute Respiratory Distress Syndrome Data Set. RESULTS: Three patterns of weaning progress were detected: sprint, consistent, and inconsistent. Length of ventilation and weaning progressively increased from the sprint, to the consistent, to the inconsistent subset. Patients in the inconsistent subset were most likely to have a systemic (sepsis or shock) trigger of acute respiratory distress syndrome and to be rated as having at least moderate disability at discharge. Hypothesis-generating univariate and then multivariate logistic regression analyses indicated that patients who experienced more days of mechanical ventilation before the start of weaning and who had a higher oxygenation index during the weaning process were most likely to have an inconsistent pattern of weaning. CONCLUSION: Patterns of weaning are discernible in a population of young children and indicate a subset at risk for inconsistent weaning. Knowing the patterns of weaning may help clinicians anticipate, perhaps plot, and then modulate a patient's weaning trajectory.

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