Ventilation Liberation Practices Among 380 International PICUs

Loberger, Jeremy; Campbell, Caitlin Marley; Colleti, José; Borasino, Santiago; Abu‐Sultaneh, Samer; Khemani, Robinder G.

doi:10.1097/cce.0000000000000710

Cited by 13 publications

(8 citation statements)

References 32 publications

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“…Protocol use was generally supported by practitioners in this survey. In contrast, previously reported unit level data from this survey demonstrated generally low adoption of ventilation liberation protocols internationally ( 21 ). The ERT eligibility variables and thresholds reported in this study provide a starting point for an ERT screening protocol.…”

Section: Discussioncontrasting

confidence: 89%

“…Development of this survey has been described previously ( 21 ). In summary, a pediatric ventilation liberation practice survey was developed and reviewed by national and international pediatric critical care experts.…”

Section: Methodsmentioning

confidence: 99%

“…Participation was solicited using two e-mails separated by 2–4 weeks. Solicitations were supported by multiple international critical care organizations ( 21 ). The survey was also promoted by one of the authors on social media using a link to the survey (Twitter, San Francisco, CA).…”

Section: Methodsmentioning

confidence: 99%

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Pediatric Ventilation Liberation: A Survey of International Practice Among 555 Pediatric Intensivists

Loberger

Campbell

Colleti

et al. 2022

Critical Care Explorations

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MAIN OUTCOMES AND MEASURES:Practices focusing on spontaneous breathing trial (SBT) eligibility, SBT practice, non-SBT extubation readiness bundle elements, and post-extubation respiratory support. RESULTS:Five-hundred fifty-five responses representing 47 countries were analyzed. Most respondents reported weaning followed by an SBT (86.4%). The top SBT eligibility variables reported were positive end-expiratory pressure (95%), Fio 2 (93.4%), and peak inspiratory pressure (73.9%). Most reported use of standardized pressure support regardless of endotracheal tube size (40.4%) with +10 cm H 2 O predominating (38.6%). SBT durations included less than or equal to 30 minutes (34.8%), 31 minutes to 1 hour (39.3%), and greater than 1 hours (26%). In assigning an SBT result, top variables were respiratory rate (94%), oxygen saturation (89.3%), and subjective work of breathing (79.8%). Most reported frequent consideration of endotracheal secretion burden (81.3%), standardized pain/sedation measurement (72.8%), fluid balance (83%), and the endotracheal air leak test as a part of extubation readiness bundles. Most reported using planned high flow nasal cannula in less than or equal to 50% of extubations (83.2%). Top subpopulations supported with planned HFNC were those with chronic lung disease (67.3%), exposed to invasive ventilation greater than 14 days (66.6%), and chronic critical illness (44.9%). Most reported using planned noninvasive ventilation (NIV) following less than or equal to 20% of extubations (79.9%). Top subpopulations supported with planned NIV were those with neuromuscular disease (72.8%), chronic lung disease (66.7%), and chronic NIV use for any reason (61.6%). Regional variation was high for most practices studied. CONCLUSION AND RELEVANCE:International pediatric ventilation liberation practices are heterogeneous. Future study is needed to address key evidence gaps. Many practice differences were associated with respondent region, which must be considered in international study design.

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Section: Discussioncontrasting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

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Pediatric Ventilation Liberation: A Survey of International Practice Among 555 Pediatric Intensivists

Loberger

Campbell

Colleti

et al. 2022

Critical Care Explorations

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“…Ventilator liberation is a daily practice in pediatric critical care, yet many aspects of pediatric ventilator liberation lack a clear evidence base. 1 , 2 , 3 , 4 , 5 , 6 There have been a multitude of studies published on aspects of pediatric ventilator liberation, but there is significant variability regarding definitions of interventions and outcomes. This variability makes it difficult to synthesize the evidence to establish best practices.…”

mentioning

confidence: 99%

Operational Definitions Related to Pediatric Ventilator Liberation

Abu‐Sultaneh¹,

Iyer²,

Fernández³

et al. 2023

Chest

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“…There is currently a significant initiative underway to understand, characterize, and evaluate the heterogeneous practices of ventilator weaning within the pediatric population 9,12,[17][18][19][20] .…”

Section: Figure 1: Diaphragm Thickening Ratio Vs Ventilator Wean Successmentioning

confidence: 99%

Diaphragmatic Ultrasound and Chest Wall Excursion Measurements in Predicting Ventilator Weaning Success amongst Pediatric Neurorehabilitation Inpatients: A Retrospective Case Series

Kunzweiler,

Bhatia,

Conley

et al. 2023

Preprint

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Background and Purpose Prompt transfer of medically stable pediatric patients with neurologic diagnoses to the inpatient rehabilitation unit is desirable to address their functional recovery. However, there is limited data on how to prioritize the need for intensive rehabilitation in the presence of ongoing need for mechanical ventilator support, outside the intensive care unit setting. This is especially true for patients who may be candidates for ventilator weaning. This dilemma involves choosing between a facility that primarily focuses on ventilator weaning, such as a long-term acute care hospital, or an inpatient rehabilitation facility that offers greater rehabilitation services but lacks evidence-based guidelines for approaching ventilator weaning in this setting. To address this challenge, this study explores the potential of leveraging inpatient rehabilitation expertise in bedside assessments of respiratory muscle function, specifically using point-of-care diaphragm ultrasound as a promising tool to guide ventilator weaning in the inpatient rehabilitation setting. Methods This is a retrospective case series conducted at a university-affiliated, freestanding acute rehabilitation hospital. We performed a retrospective chart review of pediatric patients (n=17) within this setting who, because of neurological injury or disease, relied on invasive mechanical ventilator support via tracheostomy. Patient characteristics including primary rehabilitation diagnosis were recorded, along with number of hours per day the patient relied on mechanical ventilator support at admission and then at discharge from inpatient rehabilitation hospital. Routinely performed assessments of respiratory muscle function at our facility included three modalities: (i) diaphragm muscle ultrasound B-mode measurements; (ii) inspiratory excursion measurements which measure the expansion of the chest and abdominal wall at specific sites during both tidal volume and vital capacity breaths; and (iii) pulmonary function measures - vital capacity and negative inspiratory force. The primary focus was the length of time that the patient achieved ventilator free breathing at the time of discharge from the acute rehabilitation setting. Results We included 17 patients (age 5-18 years old), all who required full support of mechanical ventilator upon admission to inpatient rehabilitation hospital. Upon discharge, 13 of these patients were either fully or partially weaned (nocturnal ventilator use only) from invasive mechanical ventilator support. Ultrasound determined diaphragm muscle thickening ratio was the assessment most predictive of ventilator weaning outcome. Specifically, all patients with at least one hemidiaphragm that had a thickening ratio >1.2 achieved some degree of ventilator weaning during inpatient rehabilitation stay. Conclusion: For the pediatric inpatient rehabilitation population that utilizes invasive mechanical ventilation because of neurological injury or disease, ultrasound determined diaphragm muscle thickening appears to serve as a useful tool for guiding ventilator management.

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Ventilation Liberation Practices Among 380 International PICUs

Cited by 13 publications

References 32 publications

Pediatric Ventilation Liberation: A Survey of International Practice Among 555 Pediatric Intensivists

Pediatric Ventilation Liberation: A Survey of International Practice Among 555 Pediatric Intensivists

Operational Definitions Related to Pediatric Ventilator Liberation

Diaphragmatic Ultrasound and Chest Wall Excursion Measurements in Predicting Ventilator Weaning Success amongst Pediatric Neurorehabilitation Inpatients: A Retrospective Case Series

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