Planning a Phased Guideline Implementation Strategy Across the Multicenter Ventilation Liberation for Kids (VentLib4Kids) Collaborative
Year: 2024
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: To evaluate contextual factors relevant to implementing pediatric ventilator liberation guidelines and to develop an implementation strategy for a multicenter collaborative. DESIGN: Cross-sectional qualitative analysis of a 2023/2024 survey. SETTING: International, multicenter Ventilation Liberation for Kids (VentLib4Kids) collaborative. SUBJECTS: Physicians, advanced practice providers, respiratory therapists, and nurses. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The survey was distributed to 26 PICUs representing 18 unique centers (17 in North American)-14 general medical/surgical, eight cardiac, and four mixed (1935 solicitations). All 409 responses were analyzed (prescribers 39.8%, nursing 32.8%, and respiratory therapists 27.4%). Three implementation tiers were identified based on perceptions of evidence, feasibility, positive impact, and favorability constructs. Tier A (≥ 80% agreement for all constructs) included extubation readiness testing (ERT) screening, ERT bundle, spontaneous breathing trials (SBTs), upper airway obstruction (UAO) risk mitigation, and risk stratified noninvasive respiratory support (NRS). Tier B (50-79% agreement) included standard risk SBT method, risk stratified SBT duration, and UAO risk assessment. Tier C (< 50% agreement) included high-risk SBT method, respiratory muscle strength testing, and infant NRS. The smallest perceived practice gaps were noted in tier A and the largest in tier C. The smallest practice gap was risk stratified NRS (88% agreement). The largest practice gap was respiratory muscle strength (18% agreement). In regression analysis, independently significant differences in perceptions based on role and unit type for multiple constructs were identified for UAO risk assessment, UAO risk mitigation, risk stratified NRS, and infant NRS. CONCLUSIONS: This survey study of the VentLib4Kids collaborative lays the foundation for phased implementation of the 2023 pediatric ventilator liberation guidelines. Early phases should focus on the best implementation profiles and smallest practice gaps. Later phases should address those that are more challenging. Unit- and role-based tailoring of differences should be considered for some recommendations more than others.
Source: Pediatric Critical Care Medicine
Authors: Jeremy M. Loberger, Kristine R. Hearld, Akira Nishisaki, Robinder G. Khemani, Katherine M. Steffen, Samer Abu-Sultaneh, for the Ventilation Liberation for Kids (VentLib4Kids) Investigators on behalf of the Pediatric Respiratory and Ventilation Subgroup (PREVENT) of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network
Institutions: University of Alabama at Birmingham, Children's Hospital of Philadelphia, University of Pennsylvania, University of Southern California, Children's Hospital of Los Angeles, Stanford Medicine, Stanford University, Indiana University Health, Riley Hospital for Children, Indiana University School of Medicine
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Award: G1211775394
OpenAlex ID: W4405569600