Skip Navigation LinksHome > January 2009 - Volume 10 - Issue 1 > Weaning and extubation readiness in pediatric patients*
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Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e318193724d
Special Article

Weaning and extubation readiness in pediatric patients*

Newth, Christopher J. L. MD, FRCPC; Venkataraman, Shekhar MD; Willson, Douglas F. MD; Meert, Kathleen L. MD; Harrison, Rick MD; Dean, J Michael MD; Pollack, Murray MD; Zimmerman, Jerry MD, PhD; Anand, Kanwaljeet J. S. MBBS, DPhil; Carcillo, Joseph A. MD; Nicholson, Carol E. MD; the Eunice Shriver Kennedy National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network

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Abstract

Objective: A systematic review of weaning and extubation for pediatric patients on mechanical ventilation.

Data Selection: Pediatric and adult literature, English language.

Study Selection: Invited review.

Data Sources: Literature review using National Library of Medicine PubMed from January 1972 until April 2008, earlier cross-referenced article citations, the Cochrane Database of Systematic Reviews, and the Internet.

Conclusions: Despite the 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 even less clear, although a trial of spontaneous breathing would seem a prerequisite. Several indices have been developed in an attempt to predict weaning and extubation success but the available literature would suggest they offer no improvement over clinical judgment. Extubation failure rates range from 2% to 20% and bear little relationship to the duration of mechanical ventilation. Upper airway obstruction is the single most common cause of extubation failure. A reliable method of assessing readiness for weaning and predicting extubation success is not evident from the pediatric literature.

©2009The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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