Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: A randomized controlled trial

Adrienne G. Randolph, David Wypij, Shekhar T. Venkataraman, James H. Hanson, Rainer G. Gedeit, Kathleen L. Meert, Peter M. Luckett, Peter Forbes, Michelle Lilley, John Thompson, Ira M. Cheifetz, Patricia Hibberd, Randall Wetzel, Peter N. Cox, John H. Arnold

Research output: Contribution to journalArticle

253 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2561-2568
Number of pages8
JournalJournal of the American Medical Association
Volume288
Issue number20
DOIs
StatePublished - Nov 27 2002

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Ventilator Weaning
Weaning
Randomized Controlled Trials
Mechanical Ventilators
Pressure
Pediatric Intensive Care Units
Random Allocation
North America
Hypnotics and Sedatives
Artificial Respiration
Respiration

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Randolph, A. G., Wypij, D., Venkataraman, S. T., Hanson, J. H., Gedeit, R. G., Meert, K. L., ... Arnold, J. H. (2002). Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: A randomized controlled trial. Journal of the American Medical Association, 288(20), 2561-2568. https://doi.org/10.1001/jama.288.20.2561

Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children : A randomized controlled trial. / Randolph, Adrienne G.; Wypij, David; Venkataraman, Shekhar T.; Hanson, James H.; Gedeit, Rainer G.; Meert, Kathleen L.; Luckett, Peter M.; Forbes, Peter; Lilley, Michelle; Thompson, John; Cheifetz, Ira M.; Hibberd, Patricia; Wetzel, Randall; Cox, Peter N.; Arnold, John H.

In: Journal of the American Medical Association, Vol. 288, No. 20, 27.11.2002, p. 2561-2568.

Research output: Contribution to journalArticle

Randolph, AG, Wypij, D, Venkataraman, ST, Hanson, JH, Gedeit, RG, Meert, KL, Luckett, PM, Forbes, P, Lilley, M, Thompson, J, Cheifetz, IM, Hibberd, P, Wetzel, R, Cox, PN & Arnold, JH 2002, 'Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: A randomized controlled trial', Journal of the American Medical Association, vol. 288, no. 20, pp. 2561-2568. https://doi.org/10.1001/jama.288.20.2561
Randolph, Adrienne G. ; Wypij, David ; Venkataraman, Shekhar T. ; Hanson, James H. ; Gedeit, Rainer G. ; Meert, Kathleen L. ; Luckett, Peter M. ; Forbes, Peter ; Lilley, Michelle ; Thompson, John ; Cheifetz, Ira M. ; Hibberd, Patricia ; Wetzel, Randall ; Cox, Peter N. ; Arnold, John H. / Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children : A randomized controlled trial. In: Journal of the American Medical Association. 2002 ; Vol. 288, No. 20. pp. 2561-2568.
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abstract = "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.",
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AU - Randolph, Adrienne G.

AU - Wypij, David

AU - Venkataraman, Shekhar T.

AU - Hanson, James H.

AU - Gedeit, Rainer G.

AU - Meert, Kathleen L.

AU - Luckett, Peter M.

AU - Forbes, Peter

AU - Lilley, Michelle

AU - Thompson, John

AU - Cheifetz, Ira M.

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AU - Wetzel, Randall

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N2 - 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.

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