• Samer Abu-Sultaneh, Narayan Prabhu Iyer, Analía Fernández, Michael Gaies, Sebastián González-Dambrauskas, Justin Christian Hotz, KneyberMartin C JMCJUniversity Medical Centre Groningen Beatrix Childrens Hospital, Department of Paediatrics, Division of Paediatric Critical Care Medicine, Groningen, Netherlands., Yolanda M López-Fernández, Alexandre T Rotta, David K Werho, Arun Kumar Baranwal, Bronagh Blackwood, Hannah J Craven, CurleyMartha A QMAQUniversity of Pennsylvania School of Nursing, Family and Community Health, Philadelphia, Pennsylvania, United States.The Children's Hospital of Philadelphia, Research Institute, Philadelphia, Pennsylvania, United States., Sandrine Essouri, Jose Roberto Fioretto, Silvia Mm Hartmann, Philippe Jouvet, Steven Kwasi Korang, Gerrard F Rafferty, Padmanabhan Ramnarayan, Louise Rose, Lyvonne N Tume, Elizabeth C Whipple, Judith Ju Ming Wong, Guillaume Emeriaud, Christopher W Mastropietro, Natalie Napolitano, NewthChristopher J LCJLUniversity of Southern California Keck School of Medicine, Los Angeles, California, United States.Children's Hospital of Los Angeles, Department of Anesthesiology and Critical Care, Los Angeles, California, United States., and Robinder G Khemani.
• Indiana University School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care, Indianapolis, Indiana, United States.
• Am. J. Respir. Crit. Care Med. 2022 Aug 15.

RationalePediatric 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.MethodsTwenty-six international experts comprised a multi-professional panel to establish pediatric 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. Systematic review was conducted for questions which 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, drafted, and voted on the recommendations.Measurements And Main ResultsThree questions related to systematic screening, using an extubation readiness testing bundle and use of a spontaneous breathing trial as part of the bundle met Modified Convergence of Opinion on Recommendations criteria of ≥80% agreement. For the remaining 8 questions, 5 systematic reviews yielded 12 recommendations related to the methods and duration of spontaneous breathing trials; measures of respiratory muscle strength; assessment of risk of post-extubation upper airway obstruction and its prevention; use of post-extubation non-invasive respiratory support; and sedation. Most recommendations were conditional and based on low to very low certainty of evidence.ConclusionThis clinical practice guideline provides a conceptual framework with evidence-based recommendations for best practices related to pediatric ventilator liberation. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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