Factors Associated with Weaning Success from Prolonged Mechanical Ventilation in Surviving Chinese Pediatric Intensive Care Units: A Multicenter Analysis

Tian Li¹Zhengzheng Zhang^2,3Hong Ren⁴Chengjun Liu⁵Zihao Yang⁶Yibing Cheng⁷Wei Xu⁸Dong Qu⁹Hengmiao Gao¹⁰Furong Zhang¹¹Hongjun Miao¹²Feng Ye¹Musheng Li¹Jianping Tao¹Jianhui Zhang¹Li Huang^1*Weiming Chen^3*

• ¹Guangzhou Medical University Guangzhou Women and Children's Medical Center, Guangzhou, China
• ²fudan university, shanghai, China
• ³Children's Hospital of Fudan University, Shanghai, China
• ⁴Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
• ⁵Children’s Hospital of Chongqing Medical University, chongqing, China
• ⁶Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, China
• ⁷Children’s Hospital Affiliated to Zhengzhou University, Zhengzhou, China
• ⁸Department of pediatric intensive care unit, National Children’s (Northeast) Regional Medical Center, Shengjing Hospital of China Medical University, Shenyang, China
• ⁹Childre’s hospital, Capital Institute of Pediatrics, Beijing, China
• ¹⁰Beijing Children's Hospital Capital Medical University, Beijing, China
• ¹¹Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
• ¹²Children's Hospital of Nanjing Medical University, Nanjing, China

Objective: To describe factors of ventilation strategies associated with weaning success for surviving patients from prolonged mechanical ventilation (PMV) in Pediatric Intensive Care Units (PICUs). Methods: 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: 58.1% (136 patients) successfully weaned, includeing 11.1% (26 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 (FiO2) on PMV diagnosis day associated with weaning failure, the OR value is 0.674. While lower airway diseases had one more times chance of weaning seccess than central nervous system diseases, the OR value is 2.144. Conclusion: Among survivors, ventilation strategies for PMV weaning in Chinese PICUs are diverse, with pressure control commonly used initially, followed by SIMV and PSV. We identified a higher FiO2 at PMV diagnosis as risk factors for weaning failure, while lower airway diseases were easier to wean.