Operational Definitions Related to Pediatric Ventilator Liberation

Abu‐Sultaneh, Samer; Iyer, Narayan P.; Fernández, A.; Gaies, Michael; González‐Dambrauskas, Sebastián; Hotz, Justin; Kneyber, Martin C. J.; López-Fernández, Yolanda M; Rotta, Alexandre T.; Werho, David K.; Baranwal, Arun; Blackwood, Bronagh; Craven, Hannah; Curley, Martha A. Q.; Essouri, Sandrine; Fioretto, José Roberto; Hartmann, Silvia; Jouvet, Philippe; Korang, Steven Kwasi; Rafferty, Gerrard F.; Ramnarayan, Padmanabhan; Rose, Louise; Tume, Lyvonne N; Whipple, Elizabeth C.; Wong, Johnson; Émériaud, Guillaume; Mastropietro, Christopher W.; Napolitano, Natalie; Newth, Christopher J. L.; Khemani, Robinder G.

doi:10.1016/j.chest.2022.12.010

Cited by 13 publications

(8 citation statements)

References 70 publications

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“…The present survey allowed to clarify the definition of weaning and weaning failure and confirmed the definitions proposed by Abu-Sultaneh et al 8 However, it revealed how challenging is to find a strong consensus about the criteria to initiate weaning and the strategy to discontinue the noninvasive respiratory support. As reported by Yoder et al in a consensus approach regarding the neonatal population, the FiO 2 and the respiratory examination seems to be reliable indicators for weaning from high-flow nasal cannula.…”

Section: Discussionsupporting

confidence: 80%

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Weaning from noninvasive respiratory support in children in acute settings: Expert consensus statement using modified Delphi methodology

Mortamet,

Milési,

Baudin

et al. 2023

Pediatric Pulmonology

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ObjectiveTo reach a consensus on the definition and modalities of weaning from noninvasive ventilation in acute settings.DesignA modified Delphi survey using closed and open‐ended questions.SettingThree rounds of consensus determination were sent via electronic mail survey to 33 experts. The survey questionnaire had four sections: definition of weaning, definition of weaning failure, criteria to initiate weaning, and modalities of weaning. Questions where agreement had been reached on round 1 were no longer part of the survey in rounds 2 and 3.SubjectsTwenty‐five international experts from 10 countries.Measurement and Main ResultsOverall, this survey generated positive consensus from experts for 19/35 statements (9 with strong agreement and 10 with weak agreement) about weaning from noninvasive respiratory support. No negative consensus could be identified.ConclusionThe clinical practice statements issued address important aspects of definition of weaning, definition of weaning failure, criteria to initiate weaning, and modalities of weaning in acute settings.

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Section: Discussionsupporting

confidence: 80%

“…The lack of efficacy to relieve dyspnea as palliative care should be considered as criteria to initiate weaning from noninvasive respiratory support 13 10 2 7 [5][6][7][8] No consensus…”

Section: Statements Without Consensusmentioning

confidence: 99%

Weaning from noninvasive respiratory support in children in acute settings: Expert consensus statement using modified Delphi methodology

Mortamet,

Milési,

Baudin

et al. 2023

Pediatric Pulmonology

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“…To prepare this report, we used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline (eTable 1 in Supplement 1). This review was conducted as part of a project to develop clinical practice guidelines for ventilator liberation in children . The protocol for the systematic review is registered in PROSPERO (CRD42021228702).…”

Section: Methodsmentioning

confidence: 99%

Association of Extubation Failure Rates With High-Flow Nasal Cannula, Continuous Positive Airway Pressure, and Bilevel Positive Airway Pressure vs Conventional Oxygen Therapy in Infants and Young Children

et al. 2023

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ImportanceExtubation failure (EF) has been associated with worse outcomes in critically ill children. The relative efficacy of different modes of noninvasive respiratory support (NRS) to prevent EF is unknown.ObjectiveTo study the reported relative efficacy of different modes of NRS (high-flow nasal cannula [HFNC], continuous positive airway pressure [CPAP], and bilevel positive airway pressure [BiPAP]) compared to conventional oxygen therapy (COT).Data SourcesMEDLINE, Embase, and CINAHL Complete through May 2022.Study SelectionRandomized clinical trials that enrolled critically ill children receiving invasive mechanical ventilation for more than 24 hours and compared the efficacy of different modes of postextubation NRS.Data Extraction and SynthesisRandom-effects models were fit using a bayesian network meta-analysis framework. Between-group comparisons were estimated using odds ratios (ORs) or mean differences with 95% credible intervals (CrIs). Treatment rankings were assessed by rank probabilities and the surface under the cumulative rank curve (SUCRA).Main Outcomes and MeasuresThe primary outcome was EF (reintubation within 48 to 72 hours). Secondary outcomes were treatment failure (TF, reintubation plus NRS escalation or crossover to another NRS mode), pediatric intensive care unit (PICU) mortality, PICU and hospital length of stay, abdominal distension, and nasal injury.ResultsA total of 11 615 citations were screened, and 9 randomized clinical trials with a total of 1421 participants were included. Both CPAP and HFNC were found to be more effective than COT in reducing EF and TF (CPAP: OR for EF, 0.43; 95% CrI, 0.17-1.0 and OR for TF 0.27, 95% CrI 0.11-0.57 and HFNC: OR for EF, 0.64; 95% CrI, 0.24-1.0 and OR for TF, 0.34; 95% CrI, 0.16- 0.65). CPAP had the highest likelihood of being the best intervention for both EF (SUCRA, 0.83) and TF (SUCRA, 0.91). Although not statistically significant, BiPAP was likely to be better than COT for preventing both EF and TF. Compared to COT, CPAP and BiPAP were reported as showing a modest increase (approximately 3%) in nasal injury and abdominal distension.Conclusions and RelevanceThe studies included in this systematic review and network meta-analysis found that compared with COT, EF and TF rates were lower with modest increases in abdominal distension and nasal injury. Of the modes evaluated, CPAP was associated with the lowest rates of EF and TF.

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“…For this analysis, we included subjects between 2 and 18 years of age with a diagnosis of critical asthma using Virtual PICU Systems (VPS) STAR codes receiving both HFNC support and continuous albuterol. We defined HFNC as use of the Optiflow device with minimum of either ≥1 L/kg/min for patients weighing up to 10 kg and ≥10 L/min for patients above 10 kg 26 . We excluded patients receiving oxygen and bronchodilator therapy from aerosol masks who were not on HFNC.…”

Section: Methodsmentioning

confidence: 99%

“…We defined HFNC as use of the Optiflow device with minimum of either ≥1 L/kg/min for patients weighing up to 10 kg and ≥10 L/min for patients above 10 kg. 26 We excluded patients receiving oxygen and bronchodilator therapy from aerosol masks who were not on HFNC.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of a respiratory therapist driven high flow nasal cannula management protocol for pediatric critical asthma patients

Maue,

Cater,

Rogerson

et al. 2023

Pediatric Pulmonology

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IntroductionThis study aimed to determine if a respiratory therapist (RT)‐driven high flow nasal cannula (HFNC) protocol could decrease duration of HFNC use, pediatric intensive care unit (PICU) and hospital length of stay (LOS), and duration of continuous albuterol use in pediatric patients with critical asthma.MethodsThis was a quality improvement project performed at a quaternary academic PICU. Patients admitted to the PICU between 2 and 18 years of age with a diagnosis of asthma requiring continuous albuterol and HFNC were included. Implementation of an RT‐driven HFNC protocol [Plan‐Do‐Study‐Act (PDSA) 1] occurred in October 2017. Additional interventions included weaning continuous albuterol and HFNC simultaneously (PDSA 2; March 2019), adjusting HFNC wean rate (PDSA 3; July 2020), and a HFNC holiday (PDSA 4; October 2021). HFNC duration was the primary outcome. Secondary outcomes included LOS data and continuous albuterol duration. Noninvasive ventilation (NIV), invasive mechanical ventilation (IMV), and 7‐day PICU and hospital readmission rates were used as balancing measures.ResultsA total of 410 patients were included. Patient demographics and adjunct therapy use did not differ among the groups. After PDSA 2, mean HFNC duration decreased (26.8–18.1 h). Mean PICU LOS decreased (41–31.8 h). Mean hospital LOS also decreased (86.5–68 h). These outcomes remained stable during PDSA 3 and 4. Continuous albuterol duration and NIV use were unchanged, while IMV use decreased.ConclusionsAn RT‐driven HFNC protocol led to decreased length of HFNC and PICU and hospital LOS for pediatric patients with critical asthma without an increase in adverse events.

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Operational Definitions Related to Pediatric Ventilator Liberation

Cited by 13 publications

References 70 publications

Weaning from noninvasive respiratory support in children in acute settings: Expert consensus statement using modified Delphi methodology

Weaning from noninvasive respiratory support in children in acute settings: Expert consensus statement using modified Delphi methodology

Association of Extubation Failure Rates With High-Flow Nasal Cannula, Continuous Positive Airway Pressure, and Bilevel Positive Airway Pressure vs Conventional Oxygen Therapy in Infants and Young Children

Outcomes of a respiratory therapist driven high flow nasal cannula management protocol for pediatric critical asthma patients

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