Pediatric Ventilator Liberation Consensus Conference

小儿呼吸机解放共识大会

• 批准号: 10117275
• 负责人: Samer Abu-Sultaneh
• 金额: $ 3.9万
• 依托单位: CHILDREN'S HOSPITAL OF LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10117275
• 关键词: Address; Adult; Area; Breathing; Child; Childhood; Clinical; Clinical Practice Guideline; Cognitive; Committee Members; Consensus; Critical Care; Critical Illness; Critically ill children; Data; Development; Emotional; Event; Exposure to; Faculty; Failure; Functional disorder; Generations; Goals; Guidelines; Hospitals; Hybrids; Institute of Medicine (U.S.); Intensive Care; International; Intervention; Knowledge; Lead; Length; Length of Stay; Level of Evidence; Mechanical ventilation; Methodology; Methods; Monitor; Morbidity - disease rate; Narcotics; National Institute of Child Health and Human Development; Nature; Patients; Pattern; Persons; Pharmaceutical Preparations; Physiological; Physiology; Practice Guidelines; Practice Management; Process; Quality of life; Randomized Controlled Trials; Readiness; Recommendation; Research; Research Personnel; Resources; Respiratory Diaphragm; Risk; Series; Severity of illness; Speed; Teleconferences; Time; Tube; Ventilator; Ventilator-induced lung injury; Voting; Weaning; base; career; clinical care; clinical practice; comorbidity; functional disability; improved outcome; innovation; meetings; multidisciplinary; novel strategies; pediatric patients; premature; programs; respiratory; sedative; symposium; systematic review; webinar

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.

项目摘要 尽管机械通风具有挽救生命的性质，但它与并发症有关，如呼吸机- 呼吸机引起的肺损伤、呼吸机相关事件、呼吸机引起的横隔膜功能障碍和暴露于 麻醉剂和镇静剂。因此，最大限度地减少接触机械通风的时间是一种 重症监护从业者的目标，必须与过早终止机械治疗平衡 通风，可能会导致额外的并发症。 不幸的是，在呼吸机管理实践中存在着高度的可变性，特别是当它 减少呼吸机的支持和评估儿科患者是否准备好从 机械通风。虽然有一些儿科证据可以指导临床实践，但也有 其中许多研究之间的不一致之处，可能涉及不同的业务定义和 方法围绕拔管准备和拔管失败。虽然有一些很好的 关于儿科呼吸机释放方面的生理学、观察性、甚至随机对照试验， 缺乏强有力的研究数据。鉴于许多领域缺乏数据，一种标准的方法和程序 系统的审查不太可能产生足够的证据来指导实践。我们的中心假设是 创新的混合方法，将系统审查与国际专家的共识意见相结合 可以生成高质量的建议，以指导临床实践并突出未来的重要领域 研究。这个项目的主要目标是在临床证据的基础上为 评估儿科患者拔管准备情况的定义和程序，并确定优先事项 未来的研究。 为了实现这一目标，我们提出了一个为期2年的项目周期，其中包括两次面对面的会议， 由大约25名儿科机械通风方面的多学科专家组成的国际小组。我们会 使用修改后的建议和证据意见汇聚(核心)方法，即 一种新的方法来加快系统审查，并与传统的 医学方法。这些方法将包括通过一系列电话会议来提炼“P.I.C.O”的关键问题。 会议、对建议的投票、系统审查、在面对面会议上介绍调查结果、 产生以协商一致为基础的传播建议，并确定关键知识 未来研究的差距。该项目可通过以下方式对危重儿童的生活产生直接影响 提供最佳实践指南，以缩短机械通风和拔管失败的持续时间 他们与之相关的短期和长期疾病。