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

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dc.contributor.authorAbu-Sultaneh, Samer
dc.contributor.authorIyer, Narayan Prabhu
dc.contributor.authorFernández, Analía
dc.contributor.authorGaies, Michael
dc.contributor.authorGonzález-Dambrauskas, Sebastián
dc.contributor.authorHotz, Justin Christian
dc.contributor.authorKneyber, Martin C.J.
dc.contributor.authorLopez-Fernández, Yolanda M.
dc.contributor.authorRotta, Alexandre T.
dc.contributor.authorWerho, David K.
dc.contributor.authorBaranwal, Arun Kumar
dc.contributor.authorBlackwood, Bronagh
dc.contributor.authorCraven, Hannah J.
dc.contributor.authorCurley, Martha A.Q.
dc.contributor.authorEssouri, Sandrine
dc.contributor.authorFioretto, Jose Roberto [UNESP]
dc.contributor.authorHartmann, Silvia M.M.
dc.contributor.authorJouvet, Philippe
dc.contributor.authorKorang, Steven Kwasi
dc.contributor.authorRafferty, Gerrard F.
dc.contributor.authorRamnarayan, Padmanabhan
dc.contributor.authorRose, Louise
dc.contributor.authorTume, Lyvonne N.
dc.contributor.authorWhipple, Elizabeth C.
dc.contributor.authorWong, Judith J.M.
dc.contributor.authorEmeriaud, Guillaume
dc.contributor.authorMastropietro, Christopher W.
dc.contributor.authorNapolitano, Natalie
dc.contributor.authorNewth, Christopher J.L.
dc.contributor.authorKhemani, Robinder G.
dc.contributor.institutionIndiana University School of Medicine
dc.contributor.institutionIndiana University Health
dc.contributor.institutionChildren’s Hospital Los Angeles
dc.contributor.institutionUniversity of Southern California
dc.contributor.institutionAcute Care General Hospital “Carlos G. Durand
dc.contributor.institutionUniversity of Cincinnati College of Medicine
dc.contributor.institutionUniversidad de la Republica
dc.contributor.institutionUniversity of Groningen
dc.contributor.institutionCruces University Hospital
dc.contributor.institutionDuke University
dc.contributor.institutionSan Diego
dc.contributor.institutionPostgraduate Institute of Medical Education and Research
dc.contributor.institutionQueen’s University Belfast
dc.contributor.institutionChildren’s Hospital of Philadelphia
dc.contributor.institutionUniversity of Montreal
dc.contributor.institutionUniversidade Estadual Paulista (UNESP)
dc.contributor.institutionUniversity of Washington
dc.contributor.institutionCopenhagen University Hospital
dc.contributor.institutionImperial College London
dc.contributor.institutionKing’s College London
dc.contributor.institutionEdge Hill University Health Research Institute
dc.contributor.institutionKK Women’s and Children’s Hospital
dc.date.accessioned2023-07-29T13:35:10Z
dc.date.available2023-07-29T13:35:10Z
dc.date.issued2023-01-01
dc.description.abstractRationale: 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.en
dc.description.affiliationDivision of Pediatric Critical Care Department of Pediatrics Indiana University School of Medicine
dc.description.affiliationRiley Hospital for Children Indiana University Health
dc.description.affiliationFetal and Neonatal Institute Division of Neonatology Department of Pediatrics Children’s Hospital Los Angeles
dc.description.affiliationKeck School of Medicine University of Southern California
dc.description.affiliationPediatric Critical Care Unit Acute Care General Hospital “Carlos G. Durand
dc.description.affiliationDivision of Pediatric Cardiology Department of Pediatrics Cincinnati Children’s Hospital Medical Center Heart Institute University of Cincinnati College of Medicine
dc.description.affiliationRed Colaborativa Pediatrica de Latinoamerica (LARed Network) Facultad de Medicina Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell Universidad de la Republica
dc.description.affiliationDepartment of Anesthesiology and Critical Care Children’s Hospital Los Angeles
dc.description.affiliationDivision of Paediatric Critical Care Medicine Department of Paediatrics Beatrix Children’s Hospital University Medical Center Groningen University of Groningen
dc.description.affiliationDepartment of Pediatrics Biocruces-Bizkaia Health Research Institute Cruces University Hospital
dc.description.affiliationDivision of Pediatric Critical Care Medicine Department of Pediatrics Duke University
dc.description.affiliationDivision of Pediatric Cardiology Cardiothoracic Intensive Care Rady Children’s Hospital University of California San Diego
dc.description.affiliationDepartment of Pediatrics Postgraduate Institute of Medical Education and Research
dc.description.affiliationWellcome-Wolfson Institute for Experimental Medicine Queen’s University Belfast
dc.description.affiliationRuth Lilly Medical Library Indiana University School of Medicine
dc.description.affiliationFamily and Community Health University of Pennsylvania School of Nursing Philadelphia Pennsylvania Research Institute Children’s Hospital of Philadelphia
dc.description.affiliationDepartment of Pediatrics Sainte-Justine Hospital University of Montreal
dc.description.affiliationPediatric Critical Care Division Department of Pediatrics Botucatu Medical School Sao Paulo State University, Botucatu
dc.description.affiliationDivision of Critical Care Medicine Department of Pediatrics Seattle Children’s Hospital University of Washington
dc.description.affiliationCopenhagen Trial Unit Centre for Clinical Intervention Research Capital Region of Denmark Rigshospitalet Copenhagen University Hospital
dc.description.affiliationCentre for Human and Applied Physiological Sciences Faculty of Life Sciences & Medicine Imperial College London
dc.description.affiliationDepartment of Surgery and Cancer Faculty of Medicine Imperial College London
dc.description.affiliationFlorence Nightingale Faculty of Nursing Midwifery and Palliative Care King’s College London
dc.description.affiliationEdge Hill University Health Research Institute
dc.description.affiliationKK Women’s and Children’s Hospital
dc.description.affiliationChildren’s Hospital of Philadelphia
dc.description.affiliationUnespPediatric Critical Care Division Department of Pediatrics Botucatu Medical School Sao Paulo State University, Botucatu
dc.description.sponsorshipNational Institutes of Health
dc.description.sponsorshipIdNational Institutes of Health: R13HD102137
dc.format.extent17-28
dc.identifierhttp://dx.doi.org/10.1164/rccm.202204-0795SO
dc.identifier.citationAmerican Journal of Respiratory and Critical Care Medicine, v. 207, n. 1, p. 17-28, 2023.
dc.identifier.doi10.1164/rccm.202204-0795SO
dc.identifier.issn1535-4970
dc.identifier.issn1073-449X
dc.identifier.scopus2-s2.0-85145424564
dc.identifier.urihttp://hdl.handle.net/11449/248128
dc.language.isoeng
dc.relation.ispartofAmerican Journal of Respiratory and Critical Care Medicine
dc.sourceScopus
dc.subjectairway extubation
dc.subjectclinical protocols
dc.subjectmechanical ventilators
dc.subjectpediatric intensive care units
dc.subjectventilator weaning
dc.titleExecutive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Documenten
dc.typeArtigo
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