Weaning nocturnal ventilation and decannulation in a pediatric ventilator care program

Abstract

Summary Introduction Children with chronic respiratory failure and upper airway disorders may require tracheostomy placement and long-term mechanical ventilation, yet many improve to permit ventilator weaning and decannulation. Methods As a quality improvement project, we conducted a chart review of patients followed by our Ventilator Care Program who underwent evaluation for weaning nocturnal ventilation (NV) and/or decannulation from 2007–2014. We collected patient demographics and characterized location, monitoring techniques, and outcomes for patients undergoing weaning NV or decannulation. We attempted to implement end tidal carbon dioxide (ETCO2) monitoring and used linear regression to compare ETCO2 with morning pCO2. Results Weaning NV was successful in 20/21 patients. Decannulation was successful in 18/21 attempts. Once implemented, ETCO2 was piloted and successfully performed in 12 attempts (29%). Blood testing was performed in 24/42 trials (57%). When measured, the final ETCO2 result partially correlated with morning pCO2 (R2 = 0.53, P < 0.02). Neither blood testing nor ETCO2 was performed for the four patients with unsuccessful attempts. Conclusions Inpatient observation for weaning NV and decannulation is safe and, in most cases, successful. With close observation, weaning NV at home may also be safe. Blood testing and ETCO2 monitoring were frequently utilized, but rarely affected decision-making since signs of respiratory distress were observed clinically prior to testing. ETCO2 monitoring may provide reassurance without venipuncture. With our experience, we propose an algorithm for weaning NV and decannulation.

Polysomnography Provides Useful Clinical Information in the Liberation from Respiratory Technology: A Retrospective Review

“…Based on our results in combination with literature review, we propose an algorithm for weaning nocturnal HMV and decannulation (Figure ). Our algorithm combines the use of daytime capping, and downsizing the tracheostomy to determine readiness for decannulation followed by an overnight capped PSG as a final confirmation.…”

“…However, the process can be difficult and carries an element of risk. Although various protocols have been reported, there is no standard approach to this process . Most of the children in this study had an overnight PSG prior to discontinuing HMV and the remaining children were liberated in the ICU after overnight monitoring.…”

Ventilator weaning and tracheostomy decannulation in children: More than one way

“…22 Many of these were in the same children. The authors describe a safe and effective approach to weaning chronic ventilation and decannulation without the use of PSG.…”

“…In this issue of the Pediatric Pulmonology, Cristea et al 20 , Henningfeld et al 21 , and Liptzin et al 22 describe the experiences of three institutions with respect to weaning mechanical ventilation and tracheostomy decannulation.…”

Pediatric Pulmonologyyear in review 2016: Part 1

“…The American Academy of Sleep Medicine considers PSG optional in the adjustment of home ventilator settings and evaluation prior to tracheostomy decannulation . In 2016, two articles published in Pediatric Pulmonology highlighted the importance of PSG for a successful decannulation.…”