open access publication

Article, 2022

Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document

American Journal of Respiratory and Critical Care Medicine, ISSN 1535-4970, 1073-449X, Volume 207, 1, Pages 17-28, 10.1164/rccm.202204-0795so

Contributors

Abu-Sultaneh, Samer M A 0000-0002-2659-2070 (Corresponding author) [1] [2] Iyer, Narayan Prabhu [3] [4] Fernández, Analía 0000-0002-5601-9742 [5] Gaies, Michael G [6] González-Dambrauskas, Sebastián 0000-0003-4775-227X [7] Hotz, Justin Christian [4] Kneyber, Martin C. J. [8] [9] López-Fernández, Yolanda Margarita 0000-0002-3918-1326 [10] Rotta, Alexandre Tellechea 0000-0002-4406-2276 [11] Werho, David K 0000-0003-0048-9806 [12] [13] Baranwal, Arun Kumar 0000-0003-4334-2652 [14] Blackwood, Bronagh 0000-0002-4583-5381 [15] Craven, Hannah J 0000-0002-1701-3655 [1] Curley, Martha A. Q. [16] [17] Essouri, Sandrine 0000-0001-9144-0957 [18] [19] Fioretto, José Roberto [20] Hartmann, Silvia M M [21] [22] Jouvet, Philippe André 0000-0001-5684-3398 [18] [19] Korang, Steven Kwasi 0000-0002-6521-0928 [4] [23] Rafferty, Gerrard Francis 0000-0001-9520-6500 [24] Ramnarayan, Padmanabhan 0000-0003-0784-8154 [25] Rose, Louise 0000-0003-1700-3972 [26] Tume, Lyvonne Nicole 0000-0002-2547-8209 [27] Whipple, Elizabeth C 0000-0002-0103-6318 [1] Wong, Judith Ju-Ming [28] Emeriaud, Guillaume 0000-0001-6405-3054 [18] [19] Mastropietro, Christopher W 0000-0002-7409-7664 [1] [2] Napolitano, Natalie [17] Newth, Christopher J L 0000-0002-5705-5227 [3] [4] Khemani, Robinder G [3] [4]

Affiliations

  1. [1] Indiana University – Purdue University Indianapolis
    2. [NORA names: United States; America, North; OECD];
  2. [2] Riley Hospital for Children
    3. [NORA names: United States; America, North; OECD];
  3. [3] University of Southern California
    4. [NORA names: United States; America, North; OECD];
  4. [4] Children's Hospital of Los Angeles
    5. [NORA names: United States; America, North; OECD];
  5. [5] El Hospital General de Agudos Carlos G. Durand
    6. [NORA names: Argentina; America, South];

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.

Keywords

Acute, Grading of Recommendations, International, Pediatric, Pediatric Acute Lung Injury, Readiness Test, Sepsis Investigators, acute lung injury, agreement, airway obstruction, assessment, breathing trial, bundles, certainty, certainty of evidence, children, clinical practice guidelines, conceptual framework, convergence of opinions, criteria, development, duration, duration of spontaneous breathing trials, elements, evaluation, evaluation methodology, evidence, evidence-based recommendations, experts, extubation, extubation readiness test, framework, grade, guidelines, injury, international clinical practice guidelines, international experts, invasive mechanical ventilation, investigation, lack, lack of clinical practice guidelines, liberal guidelines, liberation, lung injury, measurement of respiratory muscle strength, measurements, mechanical ventilation, method, methodology, modifier, muscle strength, noninvasive respiratory support, obstruction, opinion, panel, patient readiness, pediatric ventilator liberation, postextubation, postextubation upper airway obstruction, practice, practice guidelines, prevention, questions, readiness, recommendation criteria, recommendations, respiratory muscle strength, respiratory support, review, screening, sedation, sepsis, spontaneous breathing trial, strength, study, support, systematic review, systematic screening, test, test bundle, threshold, trials, upper airway obstruction, variation, ventilation, ventilator liberation

Funders

  • Department of Health and Social Care
  • NIHR Evaluation Trials and Studies Coordinating Centre
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development
  • National Heart Lung and Blood Institute

Data Provider: Digital Science

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