Pediatric Ventilator Liberation Consensus Conference

项目摘要 尽管机械通气具有挽救生命的性质，但它与呼吸机等并发症有关- 诱导的肺损伤、呼吸机相关事件、呼吸机诱导的膈肌功能障碍和暴露于 麻醉和镇静药物。因此，最大限度地减少暴露于机械通气的时间是一个 重症监护医生的目标，必须与机械性过早终止相平衡 这可能导致额外的并发症。 不幸的是，在呼吸机管理实践中存在高度的可变性，特别是当 减少呼吸机支持并评估儿科患者是否准备好从呼吸机中解放出来， 机械通气虽然有一些儿科证据可以指导临床实践，但 这些研究中有许多不一致，可能与不同的业务定义有关， 方法围绕拔管准备和拔管失败。虽然有一些优秀的 关于小儿呼吸机释放方面的生理学、观察性甚至随机对照试验， 缺乏可靠的研究数据。鉴于许多领域缺乏数据， 系统评价不可能产生足够的证据来指导实践。我们的核心假设是， 创新的混合方法，将系统性审查与国际专家的一致意见相结合 可以产生高质量的建议，以指导临床实践，并强调未来的重要领域 research.该项目的主要目标是建立指南，通过临床证据， 评估儿科患者拔管准备的定义和过程，并确定 未来的研究。 为了实现这一目标，我们提出了一个为期2年的项目期，其中包括2个不同的， 由约25名儿科机械通气领域多学科专家组成的国际小组。我们将 使用修改后的建议和证据意见趋同（CORE）方法， 这是一种加快系统评价的新方法， 医学方法。这些方法将涉及通过一系列远程培训来改进关键的“P.I.C.O”问题， 会议、对建议进行表决、系统审查、在面对面会议上介绍调查结果， 提出基于共识的建议，以供传播，并确定关键知识 未来研究的差距。该项目可以通过以下方式对重症儿童的生活产生直接影响： 提供最佳实践指南，以减少机械通气和拔管失败的持续时间， 与之相关的短期和长期发病率

Project Summary Despite the lifesaving nature of mechanical ventilation, it is associated with complications such as ventilator- induced lung injury, ventilator-associated events, ventilator induced diaphragm dysfunction and exposure to narcotic and sedative medications. Minimizing the length of exposure to mechanical ventilation is therefore a goal of intensive care practitioners, which must be balanced against premature termination of mechanical ventilation which can lead to additional complications. Unfortunately, there is a high degree of variability in ventilator management practices, particularly when it comes to reducing ventilator support and assessing whether a pediatric patient is ready for liberation from mechanical ventilation. While there is some pediatric evidence to guide clinical practice, there are inconsistencies between many of these studies, which may relate to different operational definitions and methods surrounding extubation readiness and extubation failure. While there have been some excellent physiologic, observational, and even randomized controlled trials on aspects of pediatric ventilator liberation, robust research data is lacking. Given the lack of data in many areas, a standard approach and process of systematic review is unlikely to yield enough evidence to guide practice. Our central hypothesis is that an innovative, hybrid approach which combines systematic review with consensus opinion of international experts can generate high-quality recommendations to guide clinical practice and highlight important areas for future research. The main goal of this project is to establish guidelines, informed by clinical evidence, for the definitions and process of evaluating pediatric patients for extubation readiness, and establish priorities for future research. To achieve this goal, we propose a 2 year project period which includes 2 in-person meetings of a diverse, international panel of approximately 25 multi-disciplinary experts in pediatric mechanical ventilation. We will use the modified Convergence of Opinion on Recommendations and Evidence (CORE) methodology which is a novel approach to speed up systematic reviews and is well validated against the traditional Institute of Medicine approach. The methods will involve refinement of key “P.I.C.O” questions through a series of tele- conferences, voting on recommendations, systematic review, presentation of findings at in-person meetings, generation of the consensus-based recommendations for dissemination, and identification of key knowledge gaps for future research. This project can have an immediate impact on the lives of critically ill children by providing best practice guidelines to decrease duration of mechanical ventilation and extubation failure and their associated short- and long-term morbidities.