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Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review

To map the evidence for ventilation liberation practices in pediatric respiratory failure using the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards. DATA SOURCES: CINAHL, MEDLINE, COCHRANE, and EMBASE. Trial registers included the following: ClinicalTrials.gov...

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Autores principales: van Dijk, Jefta, Blokpoel, Robert G. T., Abu-Sultaneh, Samer, Newth, Christopher J. L., Khemani, Robinder G., Kneyber, Martin C. J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9708079/
https://www.ncbi.nlm.nih.gov/pubmed/35830707
http://dx.doi.org/10.1097/PCC.0000000000003025
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author van Dijk, Jefta
Blokpoel, Robert G. T.
Abu-Sultaneh, Samer
Newth, Christopher J. L.
Khemani, Robinder G.
Kneyber, Martin C. J.
author_facet van Dijk, Jefta
Blokpoel, Robert G. T.
Abu-Sultaneh, Samer
Newth, Christopher J. L.
Khemani, Robinder G.
Kneyber, Martin C. J.
author_sort van Dijk, Jefta
collection PubMed
description To map the evidence for ventilation liberation practices in pediatric respiratory failure using the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards. DATA SOURCES: CINAHL, MEDLINE, COCHRANE, and EMBASE. Trial registers included the following: ClinicalTrials.gov, European Union clinical trials register, International Standardized Randomized Controlled Trial Number register. STUDY SELECTION: Abstracts were screened followed by review of full text. Articles published in English language incorporating a heterogeneous population of both infants and older children were assessed. DATA EXTRACTION: None. DATA SYNTHESIS: Weaning can be considered as the process by which positive pressure is decreased and the patient becomes increasingly responsible for generating the energy necessary for effective gas exchange. With the growing use of noninvasive respiratory support, extubation can lie in the middle of the weaning process if some additional positive pressure is used after extubation, while for some extubation may constitute the end of weaning. Testing for extubation readiness is a key component of the weaning process as it allows the critical care practitioner to assess the capability and endurance of the patient’s respiratory system to resume unassisted ventilation. Spontaneous breathing trials (SBTs) are often seen as extubation readiness testing (ERT), but the SBT is used to determine if the patient can maintain adequate spontaneous ventilation with minimal ventilatory support, whereas ERT implies the patient is ready for extubation. CONCLUSIONS: Current literature suggests using a structured approach that includes a daily assessment of patient’s readiness to extubate may reduce total ventilation time. Increasing evidence indicates that such daily assessments needs to include SBTs without added pressure support. Measures of elevated load as well as measures of impaired respiratory muscle capacity are independently associated with extubation failure in children, indicating that these should also be assessed as part of ERT.
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spelling pubmed-97080792022-12-06 Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review van Dijk, Jefta Blokpoel, Robert G. T. Abu-Sultaneh, Samer Newth, Christopher J. L. Khemani, Robinder G. Kneyber, Martin C. J. Pediatr Crit Care Med Feature Review Article To map the evidence for ventilation liberation practices in pediatric respiratory failure using the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards. DATA SOURCES: CINAHL, MEDLINE, COCHRANE, and EMBASE. Trial registers included the following: ClinicalTrials.gov, European Union clinical trials register, International Standardized Randomized Controlled Trial Number register. STUDY SELECTION: Abstracts were screened followed by review of full text. Articles published in English language incorporating a heterogeneous population of both infants and older children were assessed. DATA EXTRACTION: None. DATA SYNTHESIS: Weaning can be considered as the process by which positive pressure is decreased and the patient becomes increasingly responsible for generating the energy necessary for effective gas exchange. With the growing use of noninvasive respiratory support, extubation can lie in the middle of the weaning process if some additional positive pressure is used after extubation, while for some extubation may constitute the end of weaning. Testing for extubation readiness is a key component of the weaning process as it allows the critical care practitioner to assess the capability and endurance of the patient’s respiratory system to resume unassisted ventilation. Spontaneous breathing trials (SBTs) are often seen as extubation readiness testing (ERT), but the SBT is used to determine if the patient can maintain adequate spontaneous ventilation with minimal ventilatory support, whereas ERT implies the patient is ready for extubation. CONCLUSIONS: Current literature suggests using a structured approach that includes a daily assessment of patient’s readiness to extubate may reduce total ventilation time. Increasing evidence indicates that such daily assessments needs to include SBTs without added pressure support. Measures of elevated load as well as measures of impaired respiratory muscle capacity are independently associated with extubation failure in children, indicating that these should also be assessed as part of ERT. Lippincott Williams & Wilkins 2022-07-14 2022-12 /pmc/articles/PMC9708079/ /pubmed/35830707 http://dx.doi.org/10.1097/PCC.0000000000003025 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Feature Review Article
van Dijk, Jefta
Blokpoel, Robert G. T.
Abu-Sultaneh, Samer
Newth, Christopher J. L.
Khemani, Robinder G.
Kneyber, Martin C. J.
Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review
title Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review
title_full Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review
title_fullStr Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review
title_full_unstemmed Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review
title_short Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review
title_sort clinical challenges in pediatric ventilation liberation: a meta-narrative review
topic Feature Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9708079/
https://www.ncbi.nlm.nih.gov/pubmed/35830707
http://dx.doi.org/10.1097/PCC.0000000000003025
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