Spontaneous breathing trial in the weaning process from mechanical ventilation in pediatrics: outcome and predictive factors

Introduction. The spontaneous ventilation test (SVT) in the process of liberation from pediatric invasive mechanical ventilation (IMAV) is an endorsed practice; its positivity is supported by clinical parameters. However, its results are poorly documented. Objective. To describe the results of SVT in the process of liberation from IMAV. Population and methods. Retrospective analysis. Patients with >= 48 h on IMA from March 1, 2022 to January 31, 2024. Results. 493 SVTs were analyzed in 304 patients; 71% (348) were positive and 87% (302) resulted in successful extubations. The causes of negative SVTs were increased work of breathing (70%), respiratory rate (57%), and heart rate (27%). In univariate analysis, respiratory distress as the reason for admission, maximum inspiratory pressure prior to PVE, and the use of a T-tube were predictors of negative PVE. In multivariate analysis, this association persisted for admission due to respiratory causes, higher programmed respiratory rate in the MVA, and T-tube modality. Those with negative PVE remained longer in MIV [9 (7-12) vs. 7 (4-10)] and in the ICU [11 (9-15) vs. 9 (7-12)]. Conclusion. Positive PVE predicted successful extubation in a high percentage. Respiratory distress on admission, higher programmed respiratory rate, and a higher proportion of T-tube modality were negative predictors for the test. Negative PVE was associated with longer stay in MIV and ICU.