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Unlabelled: Modern mechanical ventilation modes do not prevent ventilator-associated lung injury therefore respiratory cessation must be stopped as soon as possible. However extubation recommendations absence makes difficulties in process of weaning the infants from the mechanical ventilation., Research Objective: To assess the prognostic criteria of the extubating and weaning from mechanical ventilation in premature infants during trigger ventilation (PSV/PSV + VG)., Methods: 66 Pediatric patients were divided into two groups during the period of weaning from mechanical ventilation: PSV + PG ventilation mode was used in the group 1 (n = 33), and PSV in the group 2 (n = 33). Basic characteristics were same in both groups: gestational age 31.1 +/- 2.5 weeks, mass of body 1586.2 +/- 356.8 grams. Extubation was successful if reintubation was not needed during 48 hrs., Results: 90% of successful extubations were done when the compliance was over 1.1 ml mbar(-1). Compliance decrease under 0.75 ml mbar(-1) was an adverse prognostic criterion of the weaning from mechanical ventilation and extubation. Index breathing rate/breathing volume (RVR) can be used as general criterion of the weaning from mechanical ventilation. Progressive RVR increase to 8 is an adverse prognostic criterion of PSV/ PSV + VG mode use during the period of weaning from mechanical ventilation. Parameters of mechanical ventilation which maintain acceptable gas composition of blood and SpO2 mast be considered before extubation., Conclusion: Positive dynamics and stabilization of compliance and resistance are essential criteria of the successful weaning from mechanical ventilation and extubation. RVR can be used as objective criterion of an extubation.

Mechanical ventilation (MV) has become a general treatment in the intensive care unit in recent years. Mechanical ventilation is a resuscitation treatment; however MV causes many implications therefore it is to be finished as soon as the patient's condition begins improve. Modern transferring the patient to spontaneous breathing decreases implications number. Significant part of mechanical ventilation time (40%) is a time of weaning from mechanical ventilation. Weaning from MV is an economical, clinical and ethical problem. Many ventilation modes have introduced in clinical practice through the microprocessor technologies development. Supporting ventilation modes help to avoid some adverse effects of mechanical ventilation. The article deals with historical approaches development their advantages and limitations.

The purpose of the study is to compare the effect of SIMV and BIPAP ventilation modes for the duration of mechanical ventilation, duration of the "weaning" from a respirator, the condition of gas metabolism and hemodynamics in children transferring to spontaneous breathing. In a retrospective cohort study included 30 children (16 boys and 14 girls) aged from 1 month to 18 years, which were on mechanical ventilation for more than 24 hours and required a gradual "weaning" from the unit. The children were treated in the department of general intensive care unit of Tushino City Pediatric Hospital from January 2008 to August 2010. To all the patients with duration of mechanical ventilation of more than 48 hours, as well as with an earlier unsuccessful test of the spontaneous breathing, gradual "weaning" from the unit was conducted. Depending on which mode was used the children were divided into two groups. In the first group SIMV+ PS mode was used for "weaning", while for the second group the BIPAP+ PS mode was used. Patients in both groups did not differ in age, sex, severity of illness at admission on the scale of PRISM, nosological forms and duration of mechanical ventilation before transfer to spontaneous respiration. Transition of patients to spontaneous respiration was accompanied by adaptive changes in the indices of respiratory system and hemodynamics, most pronounced after extubation. The reliable difference in the duration of weaning from the device was (3.21 + 2.0 days in SIMV group vs. 2.75 + 1.34 days in BIPAP group, p = 0.05). In the SIMV group the frequency of desynchronization episodes was greater (SIMV--an average of 3.75 + 1.4 episodes per day compared to 2.37 + 0.85 episodes in the BIPAP group, p = 0.003). The advantages of using BIPAP+ PS mode are the duration of weaning from the unit and the synchronization with the respirator. The statistically significant estimates of the parameters of pulmonary ventilation and hemodynamics require further study.

Weaning from mechanical ventilation is an important problem in intensive care medicine. A retrospective, randomized study of 56 patients with prolong respiratory distress syndrome was carried out. The patients had received mechanical ventilation for 10,4+/-2,1 days and were considered to be ready for weaning. These patients were randomly assigned to undergo one of three weaning techniques: Synchronized intermittent mandatory ventilation (SIMV) (18 patients), Pressure support ventilation (PSV) (18 patients), Biphasic intermittent positive airway pressure (BIPAP) (20 patients). Standardized protocols were followed for each technique. The mean duration of weaning was 5 days for SIMV, 4 days for PSV and 3 days for BIPAP. After adjustment for other covariates, the rate of successful weaning was higher with BIPAP (sensitivity 95 %, specificity 91%) than with PSV (sensitivity 82%, specificity 77%) or SIMV (sensitivity 67%, specificity 62%). BIPAP mode for weaning after prolonged mechanical ventilation is declared to be the best technique.

The possibility of early extubation of the first year of life children after surgical correction of congenital heart diseases while artificial blood circulation conduction was studied. For the 1996-1999 period surgical treatment was conducted in 381 patients aged at average (5.71 +/- 3.17) month, body mass at average (5.77 +/- 1.8) kg. 163 (42.7%) patients were converted to independent respiration in 6-12 hours after operation, satisfactory clinical state and indexes of gas exchange were in 122 (74.8%), 8 patients needed reintubation. Early extubation permit to reduce of respiratory complications frequency, duration of treatment in intensive therapy unit.

Correction of postoperative heart failure by continuous dopamine infusion makes it possible to avoid a decrease in cardiac performance and development of inadequate oxygen tissue supply in the course of discontinuation of controlled lung ventilation. It has been demonstrated that in a number of cases it is necessary to increase the drug dose to prevent inadequate oxygen supply of organs and tissues in patients with exhausted tissue reserves.