PICU Ventilator Weaning — Meets Criteria for Weaning Readiness for Extubation — Clinical Pathway: ICU

Ventilator Weaning Clinical Pathway — PICU

Meets Criteria for Weaning Readiness for Extubation

This pathway guides the care of children in the PICU who are invasively mechanically ventilated and meet all of the following weaning entry criteria:

Weaning Entry Criteria

Children who meet all of the following:

  • Stable conventional mode of ventilation (PCV/VCV) that has been unchanged/non-escalated for 6 hrs
  • Mean Airway Pressure (MAP) ≤ 18
  • Stable FiO2 < 40% (FiO2 > 40% sustained for 6 hrs is not appropriate for weaning)
  • Tolerating SBS Goal of -1 or 0
  • Spontaneous breathing
  • Not under neuromuscular blockade
  • Underlying reason for intubation has resolved/is resolving such that the child will be weaned toward extubation
    • Those who require titration of ventilator settings for over/under ventilation and those with active disease instability (e.g., TBI, seizure activity, hemodynamic and/or cardiac instability.) are not appropriate

Note: Nitric oxide (iNO) should not preclude weaning. Please see PICU iNO Pathway for recommendations on weaning iNO, which can be done simultaneously with ventilator weans.

Exclusions

Children who require more critical assessment between weans and are not appropriate include:

Note: Children who have been invasively mechanically ventilated for long periods of time (> 4 weeks) and/or who are mechanically ventilated at baseline may require different approaches to weaning. Consider trial periods at lower levels of support, such as sprinting or CPAP trials, in these children.

Children with Procedural/Short-term Intubations

Perform an Extubation Readiness Assessment and extubate if appropriate:

  • Overnight postoperative care
  • Procedural sedation
  • Overnight monitoring (e.g., seizures)