2023国际临床实践指南：儿童呼吸机撤机(概要)

直Check for updatesSTATE OF THE ARTExecutive Summary:International Clinical Practice Guidelinesfor Pediatric Ventilator Liberation,A Pediatric Acute Lung Injuryand Sepsis Investigators(PALISI)Network DocumentSamer Abu-Sultaneh,Narayan Prabhu lyer3,Analia Femandez,Michael Gaies,Sebastian Gonzalez-Dambrauskas,Justin Christian Hotz,Martin C.J.Kneyber,Yolanda M.Lopez-Fernandez10,Alexandre T.Rotta11,David K.Werho2,Arun Kumar Baranwal3,Bronagh Blackwood4,Hannah J.Craven5,Martha A.Q.Curley16.17Sandrine Essouri Jose Roberto Fioretto Silvia M.M.Hartmann,Philippe Jouvet Steven Kwasi Korang1Gerrard F.Rafferty22,Padmanabhan Ramnarayan23,Louise Rose24,Lyvonne N.Tume25,Elizabeth C.Whipple15,Judith J.M.Wong,Guillaume Emeriaud,Christopher W.Mastropietro,Natalie Napolitano27,Christopher J.LNewthand Robinder G.Khemani4.;on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators(PALISI)NetworkAbstractMeasurements and Main Results:Three questions related tosystematic screening using an extubation readiness testingRationale:Pediatric-specific ventilator liberation guidelines arebundle and a spontaneous breathing trial as part of the bundlelacking despite the many studies exploring elements of extubation met Modified Convergence of Opinion on Recommendationsreadiness testing.The lack of dinical practice guidelines has ledcriteria of 80%agreement.For the remaining eightto significant and unnecessary variation in methods used toquestions,five systematic reviews yielded 12 recommendationsassess pediatric patients'readiness for extubation.related to the methods and duration of spontaneous breathingMethods:Twenty-six international experts comprised atrials,measures of respiratory muscle strength,assessment ofmultiprofessional panel to establish pediatrics-specific ventilatorrisk of postextubation upper airway obstruction and itsprevention,use of postextubation noninvasive respiratoryliberation clinical practice guidelines,focusing on acutelyhospitalized children receiving invasive mechanical ventilationsupport,and sedation.Most recommendations wereconditional and based on low to very low certainty offor more than 24 hours.Eleven key questions were identified andevidence.first prioritized using the Modified Convergence of Opinion onRecommendations and Evidence.A systematic review wasConclusions:This clinical practice guideline provides aconducted for questions that did not meet an a priori thresholdconceptual framework with evidence-based recommendations forof 80%agreement,with Grading of Recommendations,best practices related to pediatric ventilator liberation.Assessment,Development,and Evaluation methodologies appliedto develop the guidelines.The panel evaluated the evidence andKeywords:airway extubation;clinical protocols;mechanicaldrafted and voted on the recommendations.ventilators;pediatric intensive care units;ventilator weaning(Received in original fom April 25,2022;accepted in final fom August 12,2022)aThis article is open access and distributed under the