Affiliations: [a] Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA | [b] Department of General Internal Medicine, University of Louisville School of Medicine, Louisville, KY, USA | [c] Department of Palliative Medicine, University of Louisville School of Medicine, Louisville, KY, USA | [d] The Home of the Innocents, Louisville, KY, USA
Corresponding author: Heather Huxol, University of Louisville School of Medicine, 323 East Chestnut Street, Louisville, KY 40202-3866, USA. Tel.: +1 502 852 2706; E-mail:[email protected]
PURPOSE: Prolonged mechanical ventilation (PMV) in medically
fragile children is commonly used in pediatric long term extended care
facilities (P-LTEC). Currently, PMV weaning is performed in an
unstandardized fashion. Without an official protocol, patients are subjected
to delayed weaning, infection, increased mortality, and difficulty obtaining
placement at adult group homes. A step-wise approach may help these children
wean from PMV effectively. METHODS: A retrospective chart review of five tracheostomized
children with bronchopulmonary dysplasia was conducted. RESULTS: A 5-step weaning protocol was created using data collected
retrospectively. First, pressure control ventilator settings were decreased
until rate = 10, fraction of inspired oxygen = 30% and pressure support =
6-10. Second, continuous positive airway pressure (CPAP) was trialed while
awake with ventilator at night. Third, CPAP was continued for 24 hours.
Fourth, tracheostomy collar (TC) was trialed while awake, with CPAP at
night. Lastly, TC was continued for 24 hours. Advancing to Step 2 required
the most time, likely secondary to episodic illnesses, with a mean of 31.2 months.
The process required 3.2 months to advance to Step 3, 1.6 months to
achieve Step 4, and 2.6 months to attain Step 5. CONCLUSION: Using the data obtained in this case series an official
protocol could be created to wean P-LTEC residents from PMV, with reasonable
expectations of the process.
Keywords: Mechanical ventilation, weaning, pediatric long term extended care facilities, medically fragile children, bronchopulmonary dysplasia