• 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, and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.
• Children's Hospital, MICU, FA-108, 300 Longwood Ave, Boston, MA 02115, USA. adrienne.randolph@tch.harvard.edu
• JAMA. 2002 Nov 27;288(20):2561-8.

ContextVentilator 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.ObjectiveTo 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 SettingRandomized controlled trial conducted in the pediatric intensive care units of 10 children's hospitals across North America from November 1999 through April 2001.PatientsOne 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.InterventionsPatients were randomized to a PSV protocol (n = 62), VSV protocol (n = 60), or no protocol (n = 60).Main Outcome MeasuresDuration of weaning time (from randomization to successful extubation); extubation failure (any invasive or noninvasive ventilator support within 48 hours of extubation).ResultsExtubation 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).ConclusionsIn 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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