Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1164/rccm.202204-0795SO http://hdl.handle.net/11449/248128 |
Resumo: | 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. |
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Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Documentairway extubationclinical protocolsmechanical ventilatorspediatric intensive care unitsventilator weaningRationale: 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.National Institutes of HealthDivision of Pediatric Critical Care Department of Pediatrics Indiana University School of MedicineRiley Hospital for Children Indiana University HealthFetal and Neonatal Institute Division of Neonatology Department of Pediatrics Children’s Hospital Los AngelesKeck School of Medicine University of Southern CaliforniaPediatric Critical Care Unit Acute Care General Hospital “Carlos G. DurandDivision of Pediatric Cardiology Department of Pediatrics Cincinnati Children’s Hospital Medical Center Heart Institute University of Cincinnati College of MedicineRed Colaborativa Pediatrica de Latinoamerica (LARed Network) Facultad de Medicina Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell Universidad de la RepublicaDepartment of Anesthesiology and Critical Care Children’s Hospital Los AngelesDivision of Paediatric Critical Care Medicine Department of Paediatrics Beatrix Children’s Hospital University Medical Center Groningen University of GroningenDepartment of Pediatrics Biocruces-Bizkaia Health Research Institute Cruces University HospitalDivision of Pediatric Critical Care Medicine Department of Pediatrics Duke UniversityDivision of Pediatric Cardiology Cardiothoracic Intensive Care Rady Children’s Hospital University of California San DiegoDepartment of Pediatrics Postgraduate Institute of Medical Education and ResearchWellcome-Wolfson Institute for Experimental Medicine Queen’s University BelfastRuth Lilly Medical Library Indiana University School of MedicineFamily and Community Health University of Pennsylvania School of Nursing Philadelphia Pennsylvania Research Institute Children’s Hospital of PhiladelphiaDepartment of Pediatrics Sainte-Justine Hospital University of MontrealPediatric Critical Care Division Department of Pediatrics Botucatu Medical School Sao Paulo State University, BotucatuDivision of Critical Care Medicine Department of Pediatrics Seattle Children’s Hospital University of WashingtonCopenhagen Trial Unit Centre for Clinical Intervention Research Capital Region of Denmark Rigshospitalet Copenhagen University HospitalCentre for Human and Applied Physiological Sciences Faculty of Life Sciences & Medicine Imperial College LondonDepartment of Surgery and Cancer Faculty of Medicine Imperial College LondonFlorence Nightingale Faculty of Nursing Midwifery and Palliative Care King’s College LondonEdge Hill University Health Research InstituteKK Women’s and Children’s HospitalChildren’s Hospital of PhiladelphiaPediatric Critical Care Division Department of Pediatrics Botucatu Medical School Sao Paulo State University, BotucatuNational Institutes of Health: R13HD102137Indiana University School of MedicineIndiana University HealthChildren’s Hospital Los AngelesUniversity of Southern CaliforniaAcute Care General Hospital “Carlos G. DurandUniversity of Cincinnati College of MedicineUniversidad de la RepublicaUniversity of GroningenCruces University HospitalDuke UniversitySan DiegoPostgraduate Institute of Medical Education and ResearchQueen’s University BelfastChildren’s Hospital of PhiladelphiaUniversity of MontrealUniversidade Estadual Paulista (UNESP)University of WashingtonCopenhagen University HospitalImperial College LondonKing’s College LondonEdge Hill University Health Research InstituteKK Women’s and Children’s HospitalAbu-Sultaneh, SamerIyer, Narayan PrabhuFernández, AnalíaGaies, MichaelGonzález-Dambrauskas, SebastiánHotz, Justin ChristianKneyber, Martin C.J.Lopez-Fernández, Yolanda M.Rotta, Alexandre T.Werho, David K.Baranwal, Arun KumarBlackwood, BronaghCraven, Hannah J.Curley, Martha A.Q.Essouri, SandrineFioretto, Jose Roberto [UNESP]Hartmann, Silvia M.M.Jouvet, PhilippeKorang, Steven KwasiRafferty, Gerrard F.Ramnarayan, PadmanabhanRose, LouiseTume, Lyvonne N.Whipple, Elizabeth C.Wong, Judith J.M.Emeriaud, GuillaumeMastropietro, Christopher W.Napolitano, NatalieNewth, Christopher J.L.Khemani, Robinder G.2023-07-29T13:35:10Z2023-07-29T13:35:10Z2023-01-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article17-28http://dx.doi.org/10.1164/rccm.202204-0795SOAmerican Journal of Respiratory and Critical Care Medicine, v. 207, n. 1, p. 17-28, 2023.1535-49701073-449Xhttp://hdl.handle.net/11449/24812810.1164/rccm.202204-0795SO2-s2.0-85145424564Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengAmerican Journal of Respiratory and Critical Care Medicineinfo:eu-repo/semantics/openAccess2024-09-03T13:46:38Zoai:repositorio.unesp.br:11449/248128Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestrepositoriounesp@unesp.bropendoar:29462024-09-03T13:46:38Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document |
title |
Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document |
spellingShingle |
Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document Abu-Sultaneh, Samer airway extubation clinical protocols mechanical ventilators pediatric intensive care units ventilator weaning |
title_short |
Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document |
title_full |
Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document |
title_fullStr |
Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document |
title_full_unstemmed |
Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document |
title_sort |
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 |
author_facet |
Abu-Sultaneh, Samer Iyer, Narayan Prabhu Fernández, Analía Gaies, Michael González-Dambrauskas, Sebastián Hotz, Justin Christian Kneyber, Martin C.J. Lopez-Fernández, Yolanda M. Rotta, Alexandre T. Werho, David K. Baranwal, Arun Kumar Blackwood, Bronagh Craven, Hannah J. Curley, Martha A.Q. Essouri, Sandrine Fioretto, Jose Roberto [UNESP] Hartmann, Silvia M.M. Jouvet, Philippe Korang, Steven Kwasi Rafferty, Gerrard F. Ramnarayan, Padmanabhan Rose, Louise Tume, Lyvonne N. Whipple, Elizabeth C. Wong, Judith J.M. Emeriaud, Guillaume Mastropietro, Christopher W. Napolitano, Natalie Newth, Christopher J.L. Khemani, Robinder G. |
author_role |
author |
author2 |
Iyer, Narayan Prabhu Fernández, Analía Gaies, Michael González-Dambrauskas, Sebastián Hotz, Justin Christian Kneyber, Martin C.J. Lopez-Fernández, Yolanda M. Rotta, Alexandre T. Werho, David K. Baranwal, Arun Kumar Blackwood, Bronagh Craven, Hannah J. Curley, Martha A.Q. Essouri, Sandrine Fioretto, Jose Roberto [UNESP] Hartmann, Silvia M.M. Jouvet, Philippe Korang, Steven Kwasi Rafferty, Gerrard F. Ramnarayan, Padmanabhan Rose, Louise Tume, Lyvonne N. Whipple, Elizabeth C. Wong, Judith J.M. Emeriaud, Guillaume Mastropietro, Christopher W. Napolitano, Natalie Newth, Christopher J.L. Khemani, Robinder G. |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Indiana University School of Medicine Indiana University Health Children’s Hospital Los Angeles University of Southern California Acute Care General Hospital “Carlos G. Durand University of Cincinnati College of Medicine Universidad de la Republica University of Groningen Cruces University Hospital Duke University San Diego Postgraduate Institute of Medical Education and Research Queen’s University Belfast Children’s Hospital of Philadelphia University of Montreal Universidade Estadual Paulista (UNESP) University of Washington Copenhagen University Hospital Imperial College London King’s College London Edge Hill University Health Research Institute KK Women’s and Children’s Hospital |
dc.contributor.author.fl_str_mv |
Abu-Sultaneh, Samer Iyer, Narayan Prabhu Fernández, Analía Gaies, Michael González-Dambrauskas, Sebastián Hotz, Justin Christian Kneyber, Martin C.J. Lopez-Fernández, Yolanda M. Rotta, Alexandre T. Werho, David K. Baranwal, Arun Kumar Blackwood, Bronagh Craven, Hannah J. Curley, Martha A.Q. Essouri, Sandrine Fioretto, Jose Roberto [UNESP] Hartmann, Silvia M.M. Jouvet, Philippe Korang, Steven Kwasi Rafferty, Gerrard F. Ramnarayan, Padmanabhan Rose, Louise Tume, Lyvonne N. Whipple, Elizabeth C. Wong, Judith J.M. Emeriaud, Guillaume Mastropietro, Christopher W. Napolitano, Natalie Newth, Christopher J.L. Khemani, Robinder G. |
dc.subject.por.fl_str_mv |
airway extubation clinical protocols mechanical ventilators pediatric intensive care units ventilator weaning |
topic |
airway extubation clinical protocols mechanical ventilators pediatric intensive care units ventilator weaning |
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. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-07-29T13:35:10Z 2023-07-29T13:35:10Z 2023-01-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1164/rccm.202204-0795SO American Journal of Respiratory and Critical Care Medicine, v. 207, n. 1, p. 17-28, 2023. 1535-4970 1073-449X http://hdl.handle.net/11449/248128 10.1164/rccm.202204-0795SO 2-s2.0-85145424564 |
url |
http://dx.doi.org/10.1164/rccm.202204-0795SO http://hdl.handle.net/11449/248128 |
identifier_str_mv |
American Journal of Respiratory and Critical Care Medicine, v. 207, n. 1, p. 17-28, 2023. 1535-4970 1073-449X 10.1164/rccm.202204-0795SO 2-s2.0-85145424564 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
American Journal of Respiratory and Critical Care Medicine |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
17-28 |
dc.source.none.fl_str_mv |
Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
repositoriounesp@unesp.br |
_version_ |
1810021386914103296 |