Ventilation Strategies for Weaning from Prolonged Mechanical Ventilation in Pediatric Intensive Care Units in Mainland China

Objective: To describe ventilation strategies for weaning patients from prolonged mechanical ventilation (PMV) in Pediatric Intensive Care Units (PICUs). Method: Conducted a retrospective study across eleven PICUs in mainland China from January 1, 2021, to December 31, 2022. Results: 234 patients diagnosed with PMV were included in the study. Weaning Outcomes: 42.3% (99 patients) successfully weaned and extubated. 15.8% (37 patients) required only a tracheostomy. 9.8% (23 patients) needed non-invasive ventilation. 32.1% (75 patients) continued to require mechanical ventilation. 34.2% (80 patients) on invasive pressure control mode at PMV diagnosis. Pressure control was the most commonly used method. Synchronized intermittent mandatory ventilation (SIMV) used by 30.4% (71 patients). Pressure support ventilation (PSV) used by 5.1% (12 patients). 63.2% (148 patients) received physiotherapy. 44.9% (105 patients) received cough augmentation techniques. 26.9% (63 patients) underwent tracheostomy after an average of 29 days of invasive mechanical ventilation. Higher fraction of inspired oxygen (FiO 2 ) linked to weaning failure (HR=1.025). Sedation on PMV diagnosis day linked to weaning success (HR=0.392). Presence of tracheostomy associated with weaning success (HR=0.435). Patients with lower airway diseases had better weaning outcomes compared to those with central nervous system diseases (HR=0.484). Conclusion: Pressure control ventilation was the initial mode; SIMV and PSV were preferred for weaning. Higher FiO 2 on the day of the PMV diagnosis was associated with weaning failure, while sedation and tracheostomy were likely linked to weaning success. Lower airway diseases showing better outcomes than central nervous system diseases.