 |
|
Effect of Mechanical Ventilator Weaning Protocols on Respiratory Outcomes in Infants and Children
A Randomized Controlled Trial
Adrienne G. Randolph, MD, MSc;
David Wypij, PhD;
Shekhar T. Venkataraman, MD;
James H. Hanson, MD;
Rainer G. Gedeit, MD;
Kathleen L. Meert, MD;
Peter M. Luckett, MD;
Peter Forbes, MA;
Michelle Lilley, RRT;
John Thompson, RRT;
Ira M. Cheifetz, MD;
Patricia Hibberd, MD, PhD;
Randall Wetzel, MD;
Peter N. Cox, MD;
John H. Arnold, MD;
for the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
JAMA. 2002;288:2561-2568.
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 (ie, PSV).
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 April 2001.
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.
Author Affiliations: Children's Hospital, Boston, Mass (Drs Randolph, Wypij, Hibberd, and Arnold, Ms Lilley, and Mssrs Forbes and Thompson); Harvard Medical School (Drs Randolph and Arnold) and Harvard School of Public Health (Dr Wypij), Boston; Children's Hospital of Pittsburgh, Pittsburgh, Pa (Dr Venkataraman); Children's Hospital Oakland, Oakland, Calif (Dr Hanson); Children's Hospital of Wisconsin, Milwaukee (Dr Gedeit); Children's Hospital of Michigan, Detroit (Dr Meert); Children's Medical Center of Dallas, Dallas, Tex (Dr Luckett); Duke Children's Hospital, Durham, NC (Dr Cheifetz); Children's Hospital Los Angeles, Los Angeles, Calif (Dr Wetzel); The Hospital for Sick Children, Toronto, Ontario (Dr Cox).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Protocols to Improve the Care of Critically Ill Pediatric and Adult Patients
and
JAMA. ;288():2601-2603.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Dexmedetomidine vs Midazolam in Critically Ill Patients: a RCT
Munkwitz
AAP Grand Rounds 2009;22:7-7.
FULL TEXT
Incidence and Outcomes of Pediatric Acute Lung Injury
Zimmerman et al.
Pediatrics 2009;124:87-95.
ABSTRACT
| FULL TEXT
Implementation of a Respiratory Therapist-Driven Protocol for Neonatal Ventilation: Impact on the Premature Population
Hermeto et al.
Pediatrics 2009;123:e907-e916.
ABSTRACT
| FULL TEXT
Weaning From Ventilatory Support
Epstein
ACCP Crit Care Med Brd Rev 2009;20:213-226.
FULL TEXT
Discontinuing Mechanical Ventilatory Support
MacIntyre
Chest 2007;132:1049-1056.
ABSTRACT
| FULL TEXT
Weaning from mechanical ventilation
Boles et al.
Eur Respir J 2007;29:1033-1056.
ABSTRACT
| FULL TEXT
A Multicenter Randomized Trial of Computer-driven Protocolized Weaning from Mechanical Ventilation
Lellouche et al.
Am. J. Respir. Crit. Care Med. 2006;174:894-900.
ABSTRACT
| FULL TEXT
Effect of Prone Positioning on Clinical Outcomes in Children With Acute Lung Injury: A Randomized Controlled Trial
Curley et al.
JAMA 2005;294:229-237.
ABSTRACT
| FULL TEXT
Pediatric Acute Lung Injury: Prospective Evaluation of Risk Factors Associated with Mortality
Flori et al.
Am. J. Respir. Crit. Care Med. 2005;171:995-1001.
ABSTRACT
| FULL TEXT
Influence of Potassium Dichromate on Tracheal Secretions in Critically Ill Patients
Frass et al.
Chest 2005;127:936-941.
ABSTRACT
| FULL TEXT
Streamlining weaning: protocols and weaning units
Simonds
Thorax 2005;60:175-182.
FULL TEXT
Protocol-Driven Ventilator Management in Children: Comparison to Nonprotocol Care
Restrepo et al.
J Intensive Care Med 2004;19:274-284.
ABSTRACT
Positive Clinical Trials: Understand the Control Group before Implementing the Result
Parshuram and Kavanagh
Am. J. Respir. Crit. Care Med. 2004;170:223-226.
FULL TEXT
Weaning by Protocol
Manthous et al.
Am. J. Respir. Crit. Care Med. 2004;170:98-100.
FULL TEXT
A Prospective, Controlled Trial of a Protocol-based Strategy to Discontinue Mechanical Ventilation
Krishnan et al.
Am. J. Respir. Crit. Care Med. 2004;169:673-678.
ABSTRACT
| FULL TEXT
OTHER ARTICLES NOTED (25 Apr 2003 to 18 Jul 2003)
Evid. Based Nurs. 2003;6:e1-12.
FULL TEXT
The Feasibility of Conducting Clinical Trials in Infants and Children with Acute Respiratory Failure
Randolph et al.
Am. J. Respir. Crit. Care Med. 2003;167:1334-1340.
ABSTRACT
| FULL TEXT
Protocols to Improve the Care of Critically Ill Pediatric and Adult Patients
Meade and Ely
JAMA 2002;288:2601-2603.
FULL TEXT
|
