TY - JOUR
T1 - Executive Summary
T2 - International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A 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 Mm
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 Ju Ming
AU - Emeriaud, Guillaume
AU - Mastropietro, Christopher W
AU - Napolitano, Natalie
AU - Newth, Christopher J L
AU - Khemani, Robinder G
PY - 2023
Y1 - 2023
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. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
U2 - 10.1164/rccm.202204-0795OC
DO - 10.1164/rccm.202204-0795OC
M3 - Journal 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 -