Abstract：
Children who require home mechanical ventilation (HMV) with an artificial airway or invasive mechanical ventilation (HMV) have a possibility of successful weaning due to the potential of compensatory lung growth. Internationally accepted guidelines on how to wean from HMV in children is not available, we summarize the weaning strategies from the literature reviews combined with our 27-year experience in the Pediatric Home Respiratory Care program at the tertiary care center in Thailand. The readiness to wean is considered in patients with hemodynamic stability, having effective cough measured by maximal inspiratory pressure, requiring a fraction of inspired oxygen (FiO2) < 40%, positive end expiratory pressure <5 cmH2O, and acceptable arterial blood gases. The strategies of weaning is start weaning during the daytime while the child is awake and close monitoring is feasible. Disconnect time is gradually increased through naps and sleeping hours. Weaning from the conventional mechanical ventilator to Bilevel PAP or CPAP are optional. Factors affected the successful weaning are mainly the underlying diseases, complications, growth and development, caregivers, and resources. Weaning should be stopped during acute illness or increased work of breathing. The readiness for decannulation could be determined by using the speaking devices, tracheostomy capping, and measurement of end-expiratory pressure. Polysomnography and airway evaluation by bronchoscopy are recommended before decannulation. Weaning when the child is ready is crucial because living with HMV can be challenging and stressful. Failure to remove a tracheostomy when indicated can result in delayed speech, social problems as well as risk for infection.
摘要：
需要使用人工气道或有创机械通气（HMV）的家庭机械通气（HMV）的儿童由于代偿性肺生长的潜力而有可能成功断奶。没有国际公认的关于如何从儿童HMV断奶的准则，我们从文献综述中总结了断奶策略,并结合我们在泰国三级护理中心儿科家庭呼吸护理项目27年的经验.血流动力学稳定的患者考虑断奶准备，通过最大吸气压力测量有效咳嗽，需要小于40%的吸入氧气(FiO2)，呼气末正压<5cmH2O，和可接受的动脉血气。断奶的策略是在白天清醒时开始断奶，密切监测是可行的。断开时间通过小睡和睡眠时间逐渐增加。从常规机械呼吸机到双级PAP或CPAP的断奶是可选的。影响断奶成功的因素主要是基础疾病，并发症,成长和发展，看护者,和资源。在急性疾病或增加呼吸工作期间应停止断奶。可以通过使用说话设备来确定拔管的准备情况，气管造口术封盖，和测量呼气末压力。建议在拔管前通过支气管镜检查进行多导睡眠图和气道评估。当孩子准备好断奶是至关重要的，因为与HMV一起生活可能是具有挑战性和压力的。指示时未能移除气管造口术可导致说话延迟，社会问题以及感染风险。
