Reducing mechanical ventilation can improve outcomes for critically ill children

Trial designed to help clinicians safely wean critically ill children off ventilation - A new clinical approach that reduces the use of mechanical ventilation can greatly improve outcomes for critically ill infants and children, finds a major new UK trial involving UCL researchers. T he Sedation AND Weaning In CHildren (SANDWICH) trial, led by Queen's University Belfast, involved more than 10,000 child and infant admissions to 18 UK pediatric Intensive Care Units. Published in the Journal of the American Medical Association (JAMA), the trial - the largest of its kind in the world - assessed a multicomponent intervention designed to help clinicians safely wean critically ill children off ventilation. This is a complex process involving several stages that include recognition of patient readiness to begin the weaning process, steps to reduce ventilation while optimising sedation in order not to induce distress and removing the endotracheal tube. The 20-month trial found that a greater involvement of nurses, minimising sedation use and increasing daily testing to assess the child's readiness to come off the ventilator, significantly reduced time on mechanical ventilation. Compared to the current standard care, the study reported that in children who were expected to be on a ventilator for more than 24 hours, the intervention reduced the time on the mechanical ventilator by an average of six hours. Furthermore, in all children, regardless of whether they were expected to be on a ventilator for more or less than 24 hours, the intervention reduced the ventilation time by an average of seven hours.