OBJECTIVE:To review the findings and discuss the implications of mechanical ventilator weaning protocols in children. DESIGN:A critical appraisal of Randolph et al. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: A randomized controlled trial. JAMA 2002;288:2561-2568, and literature review. FINDINGS:There was no difference in ventilator weaning times between children randomized to a ventilator weaning protocol (pressure support, volume support, or no protocol). However, the study did show that increased sedative use during the first 24 hrs of weaning (the only time during which these data were collected) was an important predictor of weaning duration (p < .001) and weaning failure (p = .04). CONCLUSIONS:The majority of children are weaned from mechanical ventilation over a short period of time. Weaning protocols may not shorten this brief duration of weaning but may have other advantages such as improved collaboration between healthcare team members. Future research into the effects of sedation on weaning from mechanical ventilation is needed in children.

译文

目的:回顾研究结果并讨论机械呼吸机断奶方案对儿童的影响。
设计:Randolph等人的重要评估。机械呼吸机断奶方案对婴幼儿呼吸系统结局的影响:一项随机对照试验。 JAMA 2002; 288:2561-2568,以及文献综述。
结果:随机分配到呼吸机断奶方案(压力支持,容量支持或无协议)的儿童之间的呼吸机断奶时间没有差异。但是,该研究确实表明,在断奶的前24小时(收集这些数据的唯一时间)内镇静剂使用的增加是断奶持续时间(p <.001)和断奶失败(p = .04)的重要预测指标。 。
结论:大多数儿童在短时间内断奶了机械通气。断奶协议可能不会缩短这段短暂的断奶时间,但可能具有其他优势,例如改善医疗团队成员之间的协作。儿童需要镇静剂对机械通气对断奶的影响的未来研究。

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