Executive summary: International clinical practice guidelines for pediatric ventilator liberation, a Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network document
Author(s)
Abu-Sultaneh, Samer
Iyer, Narayan Prabhu
Fernandez, Analia
Gaies, Michael
Gonzalez-Dambrauskas, Sebastian
Type
Journal Article
Abstract
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 multiprofessional panel to establish pediatrics-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. A systematic review was conducted for questions that 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 and drafted and voted on the recommendations.
Measurements and Main Results: Three questions related to systematic screening using an extubation readiness testing bundle and a spontaneous breathing trial as part of the bundle met Modified Convergence of Opinion on Recommendations criteria of ⩾80% agreement. For the remaining eight questions, five systematic reviews yielded 12 recommendations related to the methods and duration of spontaneous breathing trials, measures of respiratory muscle strength, assessment of risk of postextubation upper airway obstruction and its prevention, use of postextubation noninvasive respiratory support, and sedation. Most recommendations were conditional and based on low to very low certainty of evidence.
Conclusions: This clinical practice guideline provides a conceptual framework with evidence-based recommendations for best practices related to pediatric ventilator liberation.
Methods: Twenty-six international experts comprised a multiprofessional panel to establish pediatrics-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. A systematic review was conducted for questions that 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 and drafted and voted on the recommendations.
Measurements and Main Results: Three questions related to systematic screening using an extubation readiness testing bundle and a spontaneous breathing trial as part of the bundle met Modified Convergence of Opinion on Recommendations criteria of ⩾80% agreement. For the remaining eight questions, five systematic reviews yielded 12 recommendations related to the methods and duration of spontaneous breathing trials, measures of respiratory muscle strength, assessment of risk of postextubation upper airway obstruction and its prevention, use of postextubation noninvasive respiratory support, and sedation. Most recommendations were conditional and based on low to very low certainty of evidence.
Conclusions: This clinical practice guideline provides a conceptual framework with evidence-based recommendations for best practices related to pediatric ventilator liberation.
Date Issued
2023-01-01
Date Acceptance
2022-08-12
Citation
American Journal of Respiratory and Critical Care Medicine, 2023, 207 (1), pp.17-28
ISSN
1073-449X
Publisher
American Thoracic Society
Start Page
17
End Page
28
Journal / Book Title
American Journal of Respiratory and Critical Care Medicine
Volume
207
Issue
1
Copyright Statement
© 2023 by the American Thoracic Society This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0. For commercial usage and reprints, please e-mail Diane Gern (dgern@thoracic.org).
Identifier
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000908341500009&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=a2bf6146997ec60c407a63945d4e92bb
Subjects
ACUTE RESPIRATORY-FAILURE
airway extubation
clinical protocols
CONVENTIONAL OXYGEN-THERAPY
Critical Care Medicine
ENDOTRACHEAL-TUBE
EXTUBATION READINESS
FLOW NASAL CANNULA
General & Internal Medicine
INTENSIVE-CARE
Life Sciences & Biomedicine
MECHANICAL VENTILATION
mechanical ventilators
pediatric intensive care units
POSTEXTUBATION AIRWAY-OBSTRUCTION
Respiratory System
RISK-FACTORS
Science & Technology
SPONTANEOUS BREATHING TEST
ventilator weaning
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2022-08-15