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Research ArticleSpecial Article

Ventilator Liberation in the Pediatric ICU

Christopher JL Newth, Justin C Hotz and Robinder G Khemani
Respiratory Care October 2020, 65 (10) 1601-1610; DOI: https://doi.org/10.4187/respcare.07810
Christopher JL Newth
Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, California.
Keck School of Medicine, University of Southern California, Los Angeles, California.
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  • For correspondence: [email protected]
Justin C Hotz
Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, California.
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Robinder G Khemani
Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, California.
Keck School of Medicine, University of Southern California, Los Angeles, California.
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Abstract

Despite the accepted importance of minimizing time on mechanical ventilation, only limited guidance on weaning and extubation is available from the pediatric literature. A significant proportion of patients being evaluated for weaning are actually ready for extubation, suggesting that weaning is often not considered early enough in the course of ventilation. Indications for extubation are often not clear, although a trial of spontaneous breathing on CPAP without pressure support seems an appropriate prerequisite in many cases. Several indexes have been developed to predict weaning and extubation success, but the available literature suggests they offer little or no improvement over clinical judgment. New techniques for assessing readiness for weaning and predicting extubation success are being developed but are far from general acceptance in pediatric practice. While there have been some excellent physiologic, observational, and even randomized controlled trials on aspects of pediatric ventilator liberation, robust research data are lacking. Given the lack of data in many areas, a determined approach that combines systematic review with consensus opinion of international experts could generate high-quality recommendations and terminology definitions to guide clinical practice and highlight important areas for future research in weaning, extubation readiness, and liberation from mechanical ventilation following pediatric respiratory failure.

  • weaning
  • extubation
  • mechanical ventilation
  • respiratory support
  • spontaneous breathing
  • stridor
  • pressure rate product
  • esophageal pressure measurements
  • respiratory inductance plethysmography
  • phase angles
  • maximum negative airway pressure

Footnotes

  • Correspondence: Christopher JL Newth MD FRCPC FRACP, Division of Critical Care Medicine, Department of Anesthesiology & Critical Care Medicine, Children’s Hospital Los Angeles, MS #12, 4650 Sunset Blvd, Los Angeles, CA 90027. E-mail: cnewth{at}chla.usc.edu
  • Dr Newth presented a version of this paper at the New Horizons Symposium: Pediatric Respiratory Support of the AARC Congress 2019, held November 9–12, 2019, in New Orleans, Louisiana.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2020 by Daedalus Enterprises
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In this issue

Respiratory Care: 65 (10)
Respiratory Care
Vol. 65, Issue 10
1 Oct 2020
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Ventilator Liberation in the Pediatric ICU
Christopher JL Newth, Justin C Hotz, Robinder G Khemani
Respiratory Care Oct 2020, 65 (10) 1601-1610; DOI: 10.4187/respcare.07810

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Ventilator Liberation in the Pediatric ICU
Christopher JL Newth, Justin C Hotz, Robinder G Khemani
Respiratory Care Oct 2020, 65 (10) 1601-1610; DOI: 10.4187/respcare.07810
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  • Article
    • Abstract
    • Introduction
    • Background
    • Predictive Indexes for Weaning
    • Techniques of Weaning
    • Criteria for Readiness for Extubation
    • Impact of ETTs on Weaning and Spontaneous Breathing Trials
    • Additional Technology for Assessment of Post-Extubation Upper Airway Obstruction
    • Summary
    • Footnotes
    • References
  • Figures & Data
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Keywords

  • weaning
  • extubation
  • mechanical ventilation
  • respiratory support
  • spontaneous breathing
  • stridor
  • pressure rate product
  • esophageal pressure measurements
  • respiratory inductance plethysmography
  • phase angles
  • maximum negative airway pressure

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