ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Pulmonology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1630580
This article is part of the Research TopicUse of lung ultrasound in critical ill children with acute lung diseaseView all articles
Risk factors analysis and research on the construction of early prediction model of difficult weaning in children with mechanical ventilation
Provisionally accepted
- 1PICU,Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 2PICU, Fujian Children's Hospital（Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian, China
- 3Department of Nursing, PICU,Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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To identify risk factors for difficult weaning in mechanically ventilated children and develop an early predictive nomogram. Methods: A prospective observational study was cunducted between Aug/2023 and Nov/2024 involving 205 pediatric patients from two PICUs. General demographic and clinical data were collected, along with lung ultrasound (LUS) scores obtained within 48-72 hours of initiating mechanical ventilation. Additional respiratory and oxygenation function-related parameters were also synchronously recorded. All pediatric patients were followed up to their weaning outcomes, duration of mechanical ventilation, and ICU stay days.Weaning outcomes were defined as the dependent variable, while the collected clinical indicators were treated as independent variables for univariate analysis. Multivariable logistic regression analysis was performed to identify significant predictors, and a nomogram was developed and validated using ROC and K-S curves. Results: This study included 205 mechanically ventilated pediatric patients with complete data, and the incidence of difficult weaning was 47.8%. Two independent risk factors were identified: lung ultrasound (LUS) score (OR = 2.316, 95% CI: 1.668-3.216, P < 0.001) and pediatric critical illness score (PCIS) (OR = 0.748, 95% CI: 0.639-0.875, P = 0.001). The nomogram demonstrated good discriminatory ability, with an AUC of 0.874 in the modeling cohort and 0.854 in the validation cohort. Conclusion: LUS scores and PCIS are significant early predictors of difficult weaning in mechanically ventilated pediatric patients. The validated nomogram offers a reliable tool for quantitative risk stratification, which can support the development of personalized ventilation liberation strategies.
Keywords: mechanical ventilation, Ultrasonics, Ventilator Weaning, pediatric intensive care unit, Forecasting
Received: 18 May 2025; Accepted: 21 Jul 2025.
Copyright: © 2025 Zhang, Lu, Tang, Xia, Zhang, Sun, Shen and Ren. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wenlan Zhang, PICU,Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Nanping Shen, PICU,Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Hong Ren, PICU,Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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