TY - JOUR
T1 - Executive summary: International clinical practice guidelines for pediatric ventilator liberation, a pediatric acute lung injury and sepsis investigators (PALISI) network document
AU - Abu-Sultaneh, Samer
AU - Iyer, Narayan Prabhu
AU - Fernández, Analía
AU - Gaies, Michael
AU - González-Dambrauskas, Sebastián
AU - Hotz, Justin Christian
AU - Kneyber, Martin C J
AU - López-Fernández, Yolanda M
AU - Rotta, Alexandre T
AU - Werho, David K
AU - Baranwal, Arun Kumar
AU - Blackwood, Bronagh
AU - Craven, Hannah J
AU - Curley, Martha A Q
AU - Essouri, Sandrine
AU - Fioretto, Jose Roberto
AU - Hartmann, Silvia M M
AU - Jouvet, Philippe
AU - Korang, Steven Kwasi
AU - Rafferty, Gerrard F
AU - Ramnarayan, Padmanabhan
AU - Rose, Louise
AU - Tume, Lyvonne N
AU - Whipple, Elizabeth C
AU - Wong, Judith J M
AU - Emeriaud, Guillaume
AU - Mastropietro, Christopher W
AU - Napolitano, Natalie
AU - Newth, Christopher J L
AU - Khemani, Robinder G
PY - 2023/1/1
Y1 - 2023/1/1
N2 - RATIONALE: Pediatric specific ventilator liberation guidelines are lacking despite the many studies exploring elements of extubation readiness testing. The lack of clinical practice guidelines has led to significant and unnecessary variation in methods used to assess pediatric patients' readiness for extubation.METHODS: Twenty-six international experts comprised a multi-professional panel to establish pediatric specific ventilator liberation clinical practice guidelines, focusing on acutely hospitalized children receiving invasive mechanical ventilation for more than 24 hours. Eleven key questions were identified and first prioritized using the Modified Convergence of Opinion on Recommendations and Evidence. Systematic review was conducted for questions which did not meet an a-priori threshold of ≥80% agreement, with Grading of Recommendations, Assessment, Development, and Evaluation methodologies applied to develop the guidelines. The panel evaluated the evidence, drafted, and voted on the recommendations.MEASUREMENTS AND MAIN RESULTS: Three questions related to systematic screening, using an extubation readiness testing bundle and use of a spontaneous breathing trial as part of the bundle met Modified Convergence of Opinion on Recommendations criteria of ≥80% agreement. For the remaining 8 questions, 5 systematic reviews yielded 12 recommendations related to the methods and duration of spontaneous breathing trials; measures of respiratory muscle strength; assessment of risk of post-extubation upper airway obstruction and its prevention; use of post-extubation non-invasive respiratory support; and sedation. Most recommendations were conditional and based on low to very low certainty of evidence.CONCLUSION: This clinical practice guideline provides a conceptual framework with evidence-based recommendations for best practices related to pediatric ventilator liberation.
AB - RATIONALE: Pediatric specific ventilator liberation guidelines are lacking despite the many studies exploring elements of extubation readiness testing. The lack of clinical practice guidelines has led to significant and unnecessary variation in methods used to assess pediatric patients' readiness for extubation.METHODS: Twenty-six international experts comprised a multi-professional panel to establish pediatric specific ventilator liberation clinical practice guidelines, focusing on acutely hospitalized children receiving invasive mechanical ventilation for more than 24 hours. Eleven key questions were identified and first prioritized using the Modified Convergence of Opinion on Recommendations and Evidence. Systematic review was conducted for questions which did not meet an a-priori threshold of ≥80% agreement, with Grading of Recommendations, Assessment, Development, and Evaluation methodologies applied to develop the guidelines. The panel evaluated the evidence, drafted, and voted on the recommendations.MEASUREMENTS AND MAIN RESULTS: Three questions related to systematic screening, using an extubation readiness testing bundle and use of a spontaneous breathing trial as part of the bundle met Modified Convergence of Opinion on Recommendations criteria of ≥80% agreement. For the remaining 8 questions, 5 systematic reviews yielded 12 recommendations related to the methods and duration of spontaneous breathing trials; measures of respiratory muscle strength; assessment of risk of post-extubation upper airway obstruction and its prevention; use of post-extubation non-invasive respiratory support; and sedation. Most recommendations were conditional and based on low to very low certainty of evidence.CONCLUSION: This clinical practice guideline provides a conceptual framework with evidence-based recommendations for best practices related to pediatric ventilator liberation.
KW - Respiration, Artificial - methods
KW - clinical protocols
KW - mechanical ventilators
KW - Humans
KW - ventilator weaning
KW - Child
KW - Sepsis
KW - Airway Extubation - methods
KW - airway extubation
KW - pediatric intensive care units
KW - Ventilator Weaning - methods
KW - Ventilators, Mechanical
U2 - 10.1164/rccm.202204-0795SO
DO - 10.1164/rccm.202204-0795SO
M3 - Article
C2 - 35969419
SN - 1073-449X
VL - 207
SP - 17
EP - 28
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 1
ER -