Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A PALISI Network Document
Year: 2022
Type: article
Abstract: 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.
Authors: Samer Abu-Sultaneh, Narayan Prabhu Iyer, Analía Fernández, Michael Gaies, Sebastián González-Dambrauskas, Justin Christian Hotz, Martin C.J. Kneyber, Yolanda M López-Fernández, Alexandre T. Rotta, David K Werho, Arun Kumar Baranwal, Bronagh Blackwood, Hannah J Craven, Martha A. Q. Curley, Sandrine Essouri, Jose Roberto Fioretto, Silvia MM Hartmann, Philippe Jouvet, Steven Kwasi Korang, Gerrard F Rafferty, Padmanabhan Ramnarayan, Louise Rose, Lyvonne N Tume, Elizabeth C Whipple, Judith Ju Ming Wong, Guillaume Emeriaud, Christopher W Mastropietro, Natalie Napolitano, Christopher J.L. Newth, Robinder G Khemani
Institutions: Indiana University Health, University of California, Los Angeles, Riley Hospital for Children, Indiana University Indianapolis, Indiana University School of Medicine, University of Southern California, Children's Hospital of Los Angeles, El Hospital General de Agudos Carlos G. Durand, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Universidad de la República de Uruguay, Centro Hospitalario Pereira Rossell, University Medical Center Groningen, University of Groningen, Beatrix Kinderziekenhuis, BioCruces Health research Institute, Hospital de Cruces, Duke University, Duke Medical Center, University of California San Diego, Rady Children's Hospital-San Diego, Post Graduate Institute of Medical Education and Research, Queen's University Belfast, Children's Hospital of Philadelphia, University of Pennsylvania, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Universidade Estadual Paulista (Unesp), Seattle Children's Hospital, University of Washington, Copenhagen University Hospital, Rigshospitalet, Capital Region of Denmark, King's College London, Imperial College London, Edge Hill University, KK Women's and Children's Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Award: G168556733
OpenAlex ID: W4291583439