• Samer Abu-Sultaneh, Narayan Prabhu Iyer, Analía Fernández, Michael Gaies, Sebastián González-Dambrauskas, Justin Christian Hotz, KneyberMartin C JMCJDepartment of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Yolanda M López-Fernández, Alexandre T Rotta, David K Werho, Arun Kumar Baranwal, Bronagh Blackwood, Hannah J Craven, CurleyMartha A QMAQFamily and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA; Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA., Sandrine Essouri, Jose Roberto Fioretto, Silvia M M 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 LCJLDepartment of Anesthesiology and Critical Care, Children's Hospital Los Angeles, Los Angeles, CA; Department of Anesthesiology and Critical Care, Children's Hospital Los Angeles, University of Southern California Keck School of Medi, Robinder G Khemani, and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.
• Division of Pediatric Critical Care, Department of Pediatrics Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN. Electronic address: sultaneh@iu.edu.
• Chest. 2023 May 1; 163 (5): 113011431130-1143.

BackgroundCommon, operational definitions are crucial to assess interventions and outcomes related to pediatric mechanical ventilation. These definitions can reduce unnecessary variability among research and quality improvement efforts, to ensure findings are generalizable, and can be pooled to establish best practices.Research QuestionCan we establish operational definitions for key elements related to pediatric ventilator liberation using a combination of detailed literature review and consensus-based approaches?Study Design And MethodsA panel of 26 international experts in pediatric ventilator liberation, two methodologists, and two librarians conducted systematic reviews on eight topic areas related to pediatric ventilator liberation. Through a series of virtual meetings, we established draft definitions that were voted upon using an anonymous web-based process. Definitions were revised by incorporating extracted data gathered during the systematic review and discussed in another consensus meeting. A second round of voting was conducted to confirm the final definitions.ResultsIn eight topic areas identified by the experts, 16 preliminary definitions were established. Based on initial discussion and the first round of voting, modifications were suggested for 11 of the 16 definitions. There was significant variability in how these items were defined in the literature reviewed. The final round of voting achieved ≥ 80% agreement for all 16 definitions in the following areas: what constitutes respiratory support (invasive mechanical ventilation and noninvasive respiratory support), liberation and failed attempts to liberate from invasive mechanical ventilation, liberation from respiratory support, duration of noninvasive respiratory support, total duration of invasive mechanical ventilation, spontaneous breathing trials, extubation readiness testing, 28 ventilator-free days, and planned vs rescue use of post-extubation noninvasive respiratory support.InterpretationWe propose that these consensus-based definitions for elements of pediatric ventilator liberation, informed by evidence, be used for future quality improvement initiatives and research studies to improve generalizability and facilitate comparison.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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