Ventilator weaning and extubation practices in critically ill children:An Australian and New Zealand survey of practice

Objectives: We aimed to 1) describe current weaning and extubation practices in children (protocols to identify weaning candidates, spontaneous breathing trials and other aspects of care such as sedation weaning); and 2) understand responsibilities for ventilation weaning decisions across Australian and New Zealand (ANZ). Methods: Cross-sectional survey of ANZ intensive care units (ICUs) who routinely intubate and ventilate children (Results: A senior nursing respondent from 18/22 ICUs (82%) completed the survey. Across units, most used sedation assessment tools (88%), and less often, sedation weaning tools (55%). Spontaneous awakening protocols were not used, one unit (5%) reported the use of a spontaneous breathing protocol. Two respondents reported ventilation weaning protocol (11%) were in use, with 44% of units reporting the use of extubation protocols. Weaning and extubation practices were largely perceived as medically driven, with qualitative data demonstrating a desire from most respondents for greater shared decision making. ConclusionIn ANZ, ventilation weaning and extubation practices are largely medically driven with variation in the use of protocols to support mechanical ventilation weaning and extubation in children. Our findings highlight the importance of future research to determine the impact of greater collaboration of the multidisciplinary team on weaning practices.