SIMVS (synchronized intermittentmandatory ventilation)mode and BCPAP (Boussignac continous positive airway pressure) system indifficult-to -wean critically ill infants from mechanical ventilation

Introduction: In pediatrics, the efficacy of weaning protocols is still controversial because the information reported is less consistent, so that as there are not yet reliable criteria for weaning and extubation. The aim of this study is to evaluate the use of low-level BCPAP in the weaning process from invasive mechanical ventilation (IMV) in infants with chronic respiratory failure (CRF) secondary to congenital heart disease, after cardiac surgical correction. Methods: We studied 12 critically ill infants, aged between 3 and 20 months with CRF, univenticular congenital heart disease surgically corrected, on IMV with SIMV mode, through tracheostomy tube. It was not possible to wean them according to classical procedures. We performed the weaning process with the progressive increase of the diameter of the cannula and the progressive reduction of pressure support and acts in SIMV mode, while spontaneous breathing cycles were performed with BCPAP. Results: The patients had a median stay of 48 days in the intensive care unit (ICU). In particular, ten patients presented respiratory infection. For them the endotracheal tube was utilized for a median of 25 days. Two patients didn9t present infectious complication. They underwent endotracheal IMV for a median of 18.5 days. All patients received BCPAP for a median of 14 days. The lightweight BCPAP system didn9t present tube obstructions or accidental decannulations. Conclusion: BCPAP is well tolerated in critical infants on IMV and can reduce the duration of ventilation weaning process and ICU stay, without severe complications.