Weaning Strategy of Mechanical Ventilation in Prolonged Mechanical Ventilation in Children

The process of liberating a patient from a prolonged course of mechanical ventilation is challenging for the pediatric intensive care team, and the prevalence of children requiring prolonged mechanical ventilation (PMV) for neurological and neuromuscular diseases, airway abnormalities, or chronic lung diseases is increasing, adding an additional complexity. The weaning process is highly related to PMV. Extubation failure and the need for more than one liberation attempt significantly prolong the duration of mechanical ventilation. Pediatric critical care providers should make the effort to improve the management of those patients requiring PMV. PMV patients might fall into the difficult-to-wean category. Overall, the liberation process in children with PMV should follow a standardized protocol and the same steps as any otherwise routine wean-off. Therefore, weaning in patients with PMV should follow the Clinical Practice Guidelines for Pediatric Ventilator Liberation, although keeping in mind the relevant nuances and the specific subpopulation to which the patient belongs. Additionally, noninvasive respiratory support plays a key role in weaning, as a component of de-escalation respiratory support or as a unique component of the PMV process.