Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document.
{"article_title":"Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document.","author":"\"Abu-Sultaneh, Samer , Iyer, Narayan Prabhu , Fern\u00e1ndez\"","journal_title":"American journal of respiratory and critical care medicine","issn":"1535-4970 ; Electronic","isbn":"","publication_date":"20230101","volume":"207","issue":"1","first_page":"17","page_count":"12","accession_number":"36583619","doi":"10.1164\/rccm.202204-0795SO","publisher":"American Thoracic Society","doctype":"Clinical Study; Journal Article","subjects":"Cardiology ","interest_area":["Pediatric Medicine"," Pulmonology"," Emergency Medicine"],"abstract":"<b>Rationale:<\/b> 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. <b>Methods:<\/b> 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 <i>a priori<\/i> threshold of \u2a7e80% 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. <b>Measurements and Main Results:<\/b> 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 \u2a7e80% 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. <b>Conclusions:<\/b> This clinical practice guideline provides a conceptual framework with evidence-based recommendations for best practices related to pediatric ventilator liberation.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=36583619&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Abu-Sultaneh S, Iyer NP, Fern\u00e1ndez A, Gaies M, Gonz\u00e1lez-Dambrauskas S, Hotz JC, Kneyber MCJ, L\u00f3pez-Fern\u00e1ndez YM, Rotta AT, Werho DK, Baranwal AK, Blackwood B, Craven HJ, Curley MAQ, Essouri S, Fioretto JR, Hartmann SMM, Jouvet P, Korang SK, Rafferty GF, Ramnarayan P, Rose L, Tume LN, Whipple EC, Wong JJM, Emeriaud G, Mastropietro CW, Napolitano N, Newth CJL, Khemani RG","Journal_Info":"Publisher: American Thoracic Society Country of Publication: United States NLM ID: 9421642 Publication Model: Print Cited Medium: Internet ISSN: 1535-4970 (Electronic) Linking ISSN: 1073449X NLM ISO Abbreviation: Am J Respir Crit Care Med Subsets: MEDLINE","Publication_Type":"Systematic Review; Journal Article; Research Support, Non-U.S. Gov't; Research Support, N.I.H., Extramural","Published_Date":"2023-01-01","Source":"American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2023 Jan 01; Vol. 207 (1), pp. 17-28.","Languages":"English","Electronic_ISSN":"1535-4970","MeSH_Terms":"Respiration, Artificial*\/methods , Sepsis*, Humans ; Child ; Ventilator Weaning\/methods ; Ventilators, Mechanical ; Airway Extubation\/methods","Subjects":"Humans, Child, Ventilator Weaning methods, Ventilators, Mechanical, Airway Extubation methods, Respiration, Artificial methods, Sepsis","Title_Abbreviations":"American journal of respiratory and critical care medicine","Volume":"207"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"36583619","RelevancyScore":"878","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"877.874084472656"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=36583619&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=36583619&authtype=shib&custid=ns346513&group=main&profile=eds"}
["Abu-Sultaneh S, Iyer NP, Fern\u00e1ndez A, Gaies M, Gonz\u00e1lez-Dambrauskas S, Hotz JC, Kneyber MCJ, L\u00f3pez-Fern\u00e1ndez YM, Rotta AT, Werho DK, Baranwal AK, Blackwood B, Craven HJ, Curley MAQ, Essouri S, Fioretto JR, Hartmann SMM, Jouvet P, Korang SK, Rafferty GF, Ramnarayan P, Rose L, Tume LN, Whipple EC, Wong JJM, Emeriaud G, Mastropietro CW, Napolitano N, Newth CJL, Khemani RG","Publisher: American Thoracic Society Country of Publication: United States NLM ID: 9421642 Publication Model: Print Cited Medium: Internet ISSN: 1535-4970 (Electronic) Linking ISSN: 1073449X NLM ISO Abbreviation: Am J Respir Crit Care Med Subsets: MEDLINE","Systematic Review; Journal Article; Research Support, Non-U.S. Gov't; Research Support, N.I.H., Extramural","2023-01-01","American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2023 Jan 01; Vol. 207 (1), pp. 17-28.","English","1535-4970","Respiration, Artificial*\/methods , Sepsis*, Humans ; Child ; Ventilator Weaning\/methods ; Ventilators, Mechanical ; Airway Extubation\/methods","Humans, Child, Ventilator Weaning methods, Ventilators, Mechanical, Airway Extubation methods, Respiration, Artificial methods, Sepsis","American journal of respiratory and critical care medicine","207"]
Description
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.
