PICU Ventilator Weaning — Parameters and Frequency — Clinical Pathway: ICU

Ventilator Weaning Clinical Pathway — PICU

Weaning Parameters and Frequency

Recommended Weaning Intervals

Weaning should begin when the child meets criteria. The goal of weaning is to transition children to spontaneous
ventilation with minimal positive pressure that they will be able to sustain before extubation.

Provider discretion may guide weaning of settings. Settings may be weaned individually or together. Recommend weaning respiratory rate first in both volume and pressure control ventilation modes. Providers may wean settings in larger or more frequent increments if appropriate.

For children who are trach/vented at baseline, they should not be weaned past their baseline settings.

Volume Control Ventilation (VCV)

Setting Weaning Parameter Frequency Comments Goals
Respiratory Rate (RR) 2-6 breaths per min 2-4 hrs

Wean if normal RR for age (see age-related vital sign reference ranges below)
Ventilation:
  • Maintain EtCO2 similar to prior
  • Maintain minute ventilation
  • (VE) be similar to prior
    • VE = RR x Vt
Minimize work of breathing
Pressure Support (PS) 2-4 cmH20 2-4 hrs Wean to maintain target pressure support tidal volume (Vt) ≥ 4 mL/kg
PEEP (positive end expiratory pressure) 2 cmH20 4-8 hrs -
Oxygenation:
  • Maintain Fi02 ≤ 40%
  • Maintain Sp02 ≥ 90%

 

Pressure Control Ventilation (PCV)

Setting Weaning Parameter Frequency Comments Goals
Respiratory Rate (RR) 2-6 breaths per min 2-4 hrs Wean if normal RR for age (see age-related vital sign reference ranges below)
Ventilation:
  • Maintain EtCO2 similar to prior
  • Maintain minute ventilation
  • (VE) be similar to prior
    • VE = RR x Vt
Minimize work of breathing
Pressure Support (PS) 2-4 cmH20 2-4 hrs Wean to maintain target pressure support tidal volume (Vt) ≥ 4 mL/kg
PEEP (positive end expiratory pressure)
and
PIP (peak inspiratory pressure)		 2 cmH20 4-8 hrs Wean to maintain ΔP such that target tidal volume(Vt) ≥ 6-10 mL/kg
Oxygenation:
  • Maintain Fi02 ≤ 40%
  • Maintain Sp02 ≥ 90%

Age-related Vital Sign Reference Ranges

Age Respiratory Rate
< 6 mos 20-60
6 mos - 2 yrs 15-45
2-5 yrs 15-40
> 5 yrs 10-35