Physiology driven understanding of pediatric ventilation liberation

Almost 65% of the critical ill children admitted to the pediatric intensive care unit (PICU) requires mechanical ventilation. This PhD aims to gain more insight in the method of withdrawing mechanical ventilation with the aim to let the children breathe spontaneously again, a process known as weaning.
The treatment of critical ill children at the PICU is in a country like the Netherlands among the best in the world. However, there is still not known about the best weaning strategy and which method in children offers the best chance for a complete and smooth recovery. Much of the practice is based guidelines available in the adult care or based on clinical experience. Liberation of the ventilator is seeking for a balance between respiratory load and respiratory capacity to provide an adequate gas exchange. It is a dynamic process characterized by the underlying disease severity and it can be monitored measuring esophageal pressure, from which the work of breathing can be calculated. This PhD investigated the work of breathing by using esophageal and tracheal pressure monitoring, electrical impedance tomography and electro surface electromyography and concluded that spontaneous breathing during mechanical ventilation is safe and may have potential beneficial effects on the outcome of the treatment.