The Weaning Practices from the Mechanical Ventilation in the Pediatric Intensive Care Unit at Assiut University Children Hospital

Abstract
Background: Mechanical ventilation for children and neonates is different from that for adults. While basic principles of physics and gas flow apply to all age groups, anatomical and physiological differences play a significant role in selecting the type of ventilator as well as the ventilatory modes and settings.
Upper airway in children is cephalad funnel-shaped with narrowest area being subglottic (at the level of cricoid ring), as compared to adults where the upper airway is tubular with narrowest part at the vocal cords. Airway resistance increases inversely by 4th power of radius, i.e. in an already small airway, even one mm of edema or secretions will increase the airway resistance and turbulent flow markedly, necessitating treatment of airway edema, suctioning of secretions, measures to control secretions. Low functional residual capacity (FRC: volume of air in the lungs at end of expiration) reduces the oxygen reserve and reduces the time that apnea can be allowed in a child.
Material and Methods: Medical records of children whom were connected to mechanical ventilation in the Pediatric ICU, Assiut University Children Hospital during the period from June 1, 2015 to May 30, 2016 were collected and re-viewed to choose the cases which fulfilled the inclusion criteria of the study.
Results: During the period from 1st of June, 2015 to the 30th of May, 2016, 325 patients were admitted to the pediatric ICU, 116 (35.7%) of them were critically ill intubated patients receiving mechanical ventilation and subjected to weaning process.
Conclusions: Nearly, half of the studied cases (49.1%) were successfully weaned, while weaning failure occurred in 31.1% out of the studied cases. Rest of the cases (19.8%) showed extubation failure.