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Ventilation Weaning and Extubation Readiness in Children in Pediatric Intensive Care Unit: A Review

Ventilation is one of the most common procedures in critically ill children admitted to the pediatric intensive care units (PICUs) and is associated with potential severe side effects. The longer the mechanical ventilation, the higher the risk of infections, mortality, morbidity and length of stay....

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Autores principales: Poletto, Elisa, Cavagnero, Francesca, Pettenazzo, Marco, Visentin, Davide, Zanatta, Laura, Zoppelletto, Fabrizio, Pettenazzo, Andrea, Daverio, Marco, Bonardi, Claudia Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010786/
https://www.ncbi.nlm.nih.gov/pubmed/35433554
http://dx.doi.org/10.3389/fped.2022.867739
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author Poletto, Elisa
Cavagnero, Francesca
Pettenazzo, Marco
Visentin, Davide
Zanatta, Laura
Zoppelletto, Fabrizio
Pettenazzo, Andrea
Daverio, Marco
Bonardi, Claudia Maria
author_facet Poletto, Elisa
Cavagnero, Francesca
Pettenazzo, Marco
Visentin, Davide
Zanatta, Laura
Zoppelletto, Fabrizio
Pettenazzo, Andrea
Daverio, Marco
Bonardi, Claudia Maria
author_sort Poletto, Elisa
collection PubMed
description Ventilation is one of the most common procedures in critically ill children admitted to the pediatric intensive care units (PICUs) and is associated with potential severe side effects. The longer the mechanical ventilation, the higher the risk of infections, mortality, morbidity and length of stay. Protocol-based approaches to ventilation weaning could have potential benefit in assisting the physicians in the weaning process but, in pediatrics, clear significant outcome difference related to their use has yet to be shown. Extubation failure occurs in up to 20% of patients in PICU with evidences demonstrating its occurrence related to a worse patient outcome including higher mortality. Various clinical approaches have been described to decide the best timing for extubation which can usually be achieved by performing a spontaneous breathing trial before the extubation. No clear evidence is available over which technique best predicts extubation failure. Within this review we summarize the current strategies of ventilation weaning and extubation readiness evaluation employed in the pediatric setting in order to provide an updated view on the topic to guide intensive care physicians in daily clinical practice. We performed a thorough literature search of main online scientific databases to identify principal studies evaluating different strategies of ventilation weaning and extubation readiness including pediatric patients receiving mechanical ventilation. Various strategies are available in the literature both for ventilation weaning and extubation readiness assessment with unclear clear data supporting the superiority of any approach over the others.
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spelling pubmed-90107862022-04-16 Ventilation Weaning and Extubation Readiness in Children in Pediatric Intensive Care Unit: A Review Poletto, Elisa Cavagnero, Francesca Pettenazzo, Marco Visentin, Davide Zanatta, Laura Zoppelletto, Fabrizio Pettenazzo, Andrea Daverio, Marco Bonardi, Claudia Maria Front Pediatr Pediatrics Ventilation is one of the most common procedures in critically ill children admitted to the pediatric intensive care units (PICUs) and is associated with potential severe side effects. The longer the mechanical ventilation, the higher the risk of infections, mortality, morbidity and length of stay. Protocol-based approaches to ventilation weaning could have potential benefit in assisting the physicians in the weaning process but, in pediatrics, clear significant outcome difference related to their use has yet to be shown. Extubation failure occurs in up to 20% of patients in PICU with evidences demonstrating its occurrence related to a worse patient outcome including higher mortality. Various clinical approaches have been described to decide the best timing for extubation which can usually be achieved by performing a spontaneous breathing trial before the extubation. No clear evidence is available over which technique best predicts extubation failure. Within this review we summarize the current strategies of ventilation weaning and extubation readiness evaluation employed in the pediatric setting in order to provide an updated view on the topic to guide intensive care physicians in daily clinical practice. We performed a thorough literature search of main online scientific databases to identify principal studies evaluating different strategies of ventilation weaning and extubation readiness including pediatric patients receiving mechanical ventilation. Various strategies are available in the literature both for ventilation weaning and extubation readiness assessment with unclear clear data supporting the superiority of any approach over the others. Frontiers Media S.A. 2022-04-01 /pmc/articles/PMC9010786/ /pubmed/35433554 http://dx.doi.org/10.3389/fped.2022.867739 Text en Copyright © 2022 Poletto, Cavagnero, Pettenazzo, Visentin, Zanatta, Zoppelletto, Pettenazzo, Daverio and Bonardi. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Poletto, Elisa
Cavagnero, Francesca
Pettenazzo, Marco
Visentin, Davide
Zanatta, Laura
Zoppelletto, Fabrizio
Pettenazzo, Andrea
Daverio, Marco
Bonardi, Claudia Maria
Ventilation Weaning and Extubation Readiness in Children in Pediatric Intensive Care Unit: A Review
title Ventilation Weaning and Extubation Readiness in Children in Pediatric Intensive Care Unit: A Review
title_full Ventilation Weaning and Extubation Readiness in Children in Pediatric Intensive Care Unit: A Review
title_fullStr Ventilation Weaning and Extubation Readiness in Children in Pediatric Intensive Care Unit: A Review
title_full_unstemmed Ventilation Weaning and Extubation Readiness in Children in Pediatric Intensive Care Unit: A Review
title_short Ventilation Weaning and Extubation Readiness in Children in Pediatric Intensive Care Unit: A Review
title_sort ventilation weaning and extubation readiness in children in pediatric intensive care unit: a review
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010786/
https://www.ncbi.nlm.nih.gov/pubmed/35433554
http://dx.doi.org/10.3389/fped.2022.867739
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