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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\u2010year 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 (FiO<jats:sub>2<\/jats:sub>)\u2009&lt;\u200940%, positive end expiratory pressure &lt;5\u2009cmH<jats:sub>2<\/jats:sub>O, 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\u2010expiratory pressure. Polysomnography and airway evaluation by bronchoscopy are recommended before decannulation.\u00a0Weaning 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.27008","type":"journal-article","created":{"date-parts":[[2024,4,9]],"date-time":"2024-04-09T18:56:46Z","timestamp":1712689006000},"page":"2131-2140","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Weaning strategies for children on home invasive mechanical ventilation"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0304-8304","authenticated-orcid":false,"given":"Harutai","family":"Kamalaporn","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Pulmonology,\u00a0Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok 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