Daily Practice of Mechanical Ventilation and Weaning in Turkish PICUs: A Multicenter Prospective Survey

Abstract

Objectives: To investigate conventional mechanical ventilation weaning characteristics of patients requiring conventional mechanical ventilation support for greater than 48 hours within the PICU. Design: The prospective observational multicenter cohort study was conducted at 15 hospitals. Data were being collected from November 2013 to June 2014, with two designated researchers from each center responsible for follow-up and data entry. Setting: Fifteen tertiary PICUs in Turkey. Patients: Patients between 1 month and 18 years old requiring conventional mechanical ventilation for greater than 48 hours were included. A single-center was not permitted to surpass 20% of the total sample size. Patients with no plans for conventional mechanical ventilation weaning were excluded. Interventions: Conventional mechanical ventilation Measurements and Main Results: Pertinent variables included PICU and patient demographics, including clinical data, chronic diseases, comorbid conditions, and reasons for intubation. Conventional mechanical ventilation mode and weaning data were characterized by daily ventilator parameters and blood gases. Patients were monitored until hospital discharge. Of the 410 recruited patients, 320 were included for analyses. A diagnosis of sepsis requiring intubation and high initial peak inspiratory pressures correlated with a longer weaning period (mean, 3.65 vs 1.05–2.17 d; p < 0.001). Conversely, age, admission Pediatric Risk of Mortality III scores, days of conventional mechanical ventilation before weaning, ventilator mode, and chronic disease were not related to weaning duration. Conclusions: Pediatric patients requiring conventional mechanical ventilation with a diagnosis of sepsis and high initial peak inspiratory pressures may require longer conventional mechanical ventilation weaning prior to extubation. Causative factors and optimal weaning for this cohort needs further consideration.

Point of care diaphragm ultrasound in mechanically ventilated children: A predictive tool to detect extubation failure

“…(1) recovery from primary disease-causing mechanical ventilation, (2) adequate spontaneous breathing and effective coughing, (3) increasing consciousness, (4) hemodynamic stability with minimal vasoactive support, (5) oxygenation index <6, (6) lack of excessive tracheal secretion (less need for endotracheal suctioning), (7) adequate gas exchange with positive end-expiratory pressure (PEEP) < 8 cm H 2 O and fractional oxygen concentration (fiO 2 ) < 60%. The exclusion criteria were as follows:…”

“…The use of invasive mechanical ventilation (IMV) with positive pressure is widespread in pediatric intensive care units (PICUs), with at least one-third of children being mechanically ventilated. 1,2 Prolonged IMV is associated with ventilator-related injury, increased nosocomial infection risk, longer sedation requirement 3 and diaphragmatic atrophy. 4 Ultimately, children should be weaned from the ventilator once the clinical condition improves.…”

Point of care diaphragm ultrasound in mechanically ventilated children: A predictive tool to detect extubation failure

“…Invasive mechanical ventilation (IMV) with positive pressure is widespread in pediatric intensive care units (PICUs), with at least one-third of children being mechanically ventilated. 1,2 . Prolonged IMV is associated with ventilator-related injury, increased nosocomial infection risk, longer sedation requirement 3 and diaphragmatic atrophy 4 .…”

Pressure-Regulated Volume Control and Pressure-Control Ventilation Modes in Pediatric Acute Respiratory Failure

“…Pressure-controlled ventilation modes (assist/control or synchronized intermittent mandatory ventilation) are frequently preferred modes in pediatric mechanical ventilation practice. 4 , 5 Anaesthesiologists’ choice of pressure-controlled modes due to the inability of delivering low tidal volumes with conventional (old) anaesthesia machines during pediatric anaesthesia procedures seems to be the origin of this practice. 6 , 7 The studies conducted in pediatric intensive care units in Argentina and Italy in 2003 and 2007 showed that PRVC mode usage was not common in their daily pediatric intensive care practice.…”

“… 6 , 7 The studies conducted in pediatric intensive care units in Argentina and Italy in 2003 and 2007 showed that PRVC mode usage was not common in their daily pediatric intensive care practice. 8 A recent study by Tekgüç et al 4 shows that pressure-controlled ventilation modes have been used more frequently in the weaning period than PRVC (almost 5%) in daily pediatric critical care practice in Turkey. The objective of this study is to present our clinical experience of using PRVC and PC ventilation modes in children.…”