Chest. 2024 Jun 7:S0012-3692(24)00688-3. doi: 10.1016/j.chest.2024.05.012. Online ahead of print.
ABSTRACT
BACKGROUND: The 2023 international pediatric ventilator liberation clinical practice guidelines provided evidence-based recommendations to guide pediatric critical care providers on how to perform daily aspects of ventilator liberation. However, due to the lack of high-quality pediatric studies, most recommendations were conditional based on very low to low certainty of evidence.
RESEARCH QUESTION: What are the research gaps related to pediatric ventilator liberation that can be studied to strengthen the evidence for future updates of the guidelines?
STUDY DESIGN: and Methods: We conducted systematic reviews of the literature in 8 pre-defined PICO areas related to pediatric ventilator liberation to generate recommendations. Subgroups responsible for each PICO question subsequently identified major research gaps by synthesizing the literature. These gaps were presented at an international symposium at the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) meeting in Spring 2022 for open discussion, feedback was incorporated, and final evaluation of research gaps are summarized in this document. While randomized trials trials (RCTs) represent the highest level of evidence, the panel sought to highlight areas where alternative study designs may also be appropriate, given challenges with conducting large multi-center RCTs in children.
RESULTS: Significant research gaps were identified in six broad areas related to pediatric ventilator liberation. Several of these areas necessitate multi-center RCTs to provide definitive results, while other gaps can be addressed with multi-center observational studies or quality improvement initiatives. Furthermore, there remains a need for some physiologic studies in several areas, particularly regarding newer diagnostic methods to improve identification of patients at high-risk of extubation failure.
INTERPRETATION: While pediatric ventilator liberation guidelines have been created, the certainty of evidence remains low and there are multiple research gaps which should be filled through high quality RCTs, and multi-center observational studies and quality improvement initiatives.
PMID:38852880 | DOI:10.1016/j.chest.2024.05.012
