CLINICAL AND PHYSIOLOGICAL JUSTIFICATION OF WEANING FROM MECHANICAL VENTILATION IN CHILDREN WITH RESPIRATORY FAILURE

Abstract

Children frequently are admitted to pediatric intensive care units due to acute respiratory failure and up to 64 % of them need to be mechanically ventilated and later weaned. The aim was to develop strategy of weaning from mechanical ventilation in children with different types of respiratory failure. Materials and methods. The work was based on results of treatment of 237 patients aged from 1 month to 18 years old, who were divided into control and study group. Patients of study group were randomized into group I (83 patients) and received traditional ICU monitoring and treatment and group II (79 patients), where was used proposed by us methods of monitoring and treatment. Results. There was supplemented data on the etiology of respiratory failure in children with taking into account function of diaphragm, changes in hemodynamics, nutritional status, electrolyte balance and central nervous system function. It was established new mechanisms of inadequacy of spontaneous breathing during mechanical ventilation and found causes of unsuccessful weaning from mechanical ventilation. In addition, it was developed a weaning strategy with goal-directed therapy for disorders treatment according the type of respiratory failure and children`s age. As a result, important scientific problem was solved and the results of treatment of children with respiratory failure was improved. Conclusions. It was found that proposed strategy of weaning from mechanical ventilation allowed to reduce the duration of mechanical ventilation and the frequency of complications (reintubations). There were no significant differences in the frequency of tracheostomy among patients of I and II groups.