Abstract: Background：Weaning management of patients with prolonged mechanical ventilation （PMV） and subsequent transition to home mechanical ventilation have been complex challenges for critical care teams. Objective：To explore the application of multidisciplinary treatment (MDT) model in the diagnosis and treatment of pediatric PMV and to analyze its clinical value and the significance of promotion for individualized weaning plan and transition from PMV to HMV. Design：Quality improvement. Methods：Patients with PMV in PICU were observed, and were divided into control group and intervention group according to 18 months before and after July 2020. The diagnosis and treatment measures of PMV in our hospital mainly include: prevention of ventilatorassociated pneumonia, sedation, analgesia, fluid management, nutritional support, early rehabilitation, individualized weaning program, education and followup of PMV transition to HMV, and establishment of outpatient and emergency followup for HMV specific diseases. The control group was empirically treated by different doctors or teams in the PICU. In the intervention group, the PMVMDT team led the treatment. Taking the PICU as the platform, PMVMDT parttime liaisons and core team members (respiratory therapists, rehabilitation physicians, ent physicians, nutrition physicians, etc.) were set up. The HMV special followup and emergency clinics were established. Main outcome measures：PMV transition to HMV and the application of individualized weaning technology. Results：There were 101 cases of PMV in the intervention group and 124 cases in the control group. There was no statistical difference in gender, age, weight and the primary disease causing PMV between the two groups. In the control group, 36 cases died in hospital, 67 cases were improved and discharged (44 cases discharged after weaning and extubation , 14 cases still dependent on mechanical ventilation, and 7 cases still dependent on artificial airway without mechanical ventilation), and 21 patients gave up treatment. In the intervention group, 26 cases died in hospital, 64 cases were improved and discharged (38 cases discharged after weaning and extubation, 19 cases still dependent on mechanical ventilation, and 7 cases still dependent on artificial airway without mechanical ventilation), and 11 patients gave up treatment (9 deaths, 1 case still dependent on mechanical ventilation, 1 case successfully extubated). Compared with the control group, there were more use of diaphragm ultrasound (97.0% vs 12.7%), diaphragm electrical activity monitoring technology (5% vs 0) and external diaphragm pacer (26.7% vs 0) in the intervention group, and the differences were statistically significant. There was no significant difference in the number of cases of bronchoscopy between the two groups. The esophageal pressureguided strategy and neurally adjusted ventilator assist (NAVA) mode were the first of their kind. Among 19 HMV patients in the intervention group, 3 cases were readmitted by green channel due to aggravation of pulmonary infection caused by irregular airway clearance, 1 case died, and the rest of them still insisted on HMV during followup. Fourteen cases with HMV in control group were lost to followup. In the intervention group, there were 7 cases dependent on artificial airway without mechanical ventilation, of which 1 case were extubation 3 months after discharge, and the rest were all alive during followup. There were 7 cases dependent on artificial airway without mechanical ventilation, and they were all lost to followup. There was no statistical difference between the two groups in the number of patients discharged from hospital, extubation at discharge, dependent on mechanical ventilation at discharge, dependent on artificial airway without mechanical ventilation, length of stay in ICU and duration of mechanical ventilation. Conclusions：PMVMDT model can provide systematic and individualized clinical diagnosis, treatment and weaning plan for children with ventilator dependent as early as possible. It also provides home care training before discharge and regular followup after discharge for children with HMV. All these can ensure the effectiveness and continuity of treatment strategies for children with longterm mechanical ventilation.

Key words: Prolonged mechanical ventilation, Child, Multidisciplinary treatment, Bronchoscopy, Diaphragm ultrasound, Home mechanical ventilation