Weaning nocturnal ventilation and decannulation in a pediatric ventilator care program

Introduction: Children with chronic respiratory failure and upper airway disorders may require tracheostomy placement and long-term mechanical ventilation, yet many improve to permit ventilator weaning and decannulation. Methods: As a quality improvement project, we conducted a chart review of patients followed by our Ventilator Care Program who underwent evaluation for weaning nocturnal ventilation (NV) and/or decannulation from 2007–2014. We collected patient demographics and characterized location, monitoring techniques, and outcomes for patients undergoing weaning NV or decannulation. We attempted to implement end tidal carbon dioxide (ETCO₂) monitoring and used linear regression to compare ETCO₂ with morning pCO₂. Results: Weaning NV was successful in 20/21 patients. Decannulation was successful in 18/21 attempts. Once implemented, ETCO₂ was piloted and successfully performed in 12 attempts (29%). Blood testing was performed in 24/42 trials (57%). When measured, the final ETCO₂ result partially correlated with morning pCO₂ (R² = 0.53, P < 0.02). Neither blood testing nor ETCO₂ was performed for the four patients with unsuccessful attempts. Conclusions: Inpatient observation for weaning NV and decannulation is safe and, in most cases, successful. With close observation, weaning NV at home may also be safe. Blood testing and ETCO₂ monitoring were frequently utilized, but rarely affected decision-making since signs of respiratory distress were observed clinically prior to testing. ETCO₂ monitoring may provide reassurance without venipuncture. With our experience, we propose an algorithm for weaning NV and decannulation. Pediatr Pulmonol. 2016;51:825–829.