Neuromuscular Compromise and Respiratory Failure — PICU Non-Invasive and Airway Clearance Weaning Strategies — Clinical Pathway: Inpatient and PICU

Neuromuscular Compromise and Respiratory Failure Clinical Pathway — Inpatient and PICU

PICU Non-Invasive and Airway Clearance Weaning Strategies

Settings should not be decreased until the patient’s FiO2 is 0.21, maintaining saturations (see Oxygenation Goals) TCOM values can be used as a monitor for weaning tolerance.

Weaning NIV Back to Baseline Settings
  • Wean IPAP and EPAP slowly keeping in mind to preserve a pressure delta of at least 10 cmH2O (or their home delta P if less than 10 cmH2O).
  • Once baseline or new baseline pressures and 21% FiO2 are established, proceed with room air sprints.
  • Begin trials off BIPAP to room air with a goal of baseline or nocturnal support.
    • Generally, start with 30-60 minutes BID and increase length as tolerated.
    • If desaturation is present, trial cough assist. If persisting desaturation is noted after cough assist the sprint should be stopped and BIPAP reapplied.
  • Continuous Positive Airway Pressure (CPAP) does not sufficiently reduce the ventilatory load And should not be used.
  • Sprinting with supplemental oxygen is not ideal as it can mask hypoventilation.
Weaning Airway Clearance Treatments
  • At 48 hours after initiation of IPV and/or hypertonic saline, re-evaluate frequency and need to continue treatments.
  • After 24 hours of no escalation and FiO2 0.21, begin weaning airway clearance starting with non-home therapies first.
  • Airway clearance may be weaned before NIV settings are weaned with close monitoring of secretion burden.