Le sevrage de la ventilation mécanique invasive en réanimation pédiatrique (à l’exclusion des prématurés)

Paediatric intensive care nurses' and doctors' perceptions on nurse‐led protocol‐directed ventilation weaning and extubation

“…Clearly, if there is a perception that the protocol will take longer than standard clinical weaning practice, then this will inhibit compliance with the protocol and means that the protocol is not achieving its intended goal, to facilitate more timely ventilation weaning. Two papers have published their paediatric weaning protocols (Keogh et al , ; LecLerc et al , ) and both have differences to that of ours. The Keogh et al paper () used only SIMV mode to wean, which impacts upon the way the ventilator is weaned, using only breath rate in their protocol.…”

“…In contrast, we use BIPAP (a pressure cycled mode on the Evita 4 ventilator), which enables us to wean both by pressure or breath rate. The LecLerc et al paper () is less prescriptive and emphasizes the daily testing of ‘readiness for extubation’ including adequate sedation level (and an FiO 2 ≤ 50% and PEEP ≤ 5 cm), then progresses to a spontaneous breathing trial (SBT) with little guidance as to how to get to this point.…”

Implementation of a neonatal pain management module in the computerized physician order entry system

“…However, the protocols for adult ICUs include daily interruption of analgesia/sedation to determine whether the patient can be extubated [28,29]. This strategy, which may in itself reduce the time of ventilation, is rarely used in pediatrics [30] and was not employed on our unit. In any case, the small number of subjects in our study did not permit any conclusions to be drawn regarding this secondary outcome.…”