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Pediatric Prolonged Mechanical Ventilation: Considerations for Definitional Criteria.

Michaël Sauthier1, Louise Rose2, Philippe Jouvet3

  • 1Research Center of Sainte-Justine Hospital and the Pediatric ICU, Sainte-Justine Hospital, Montreal, Québec, Canada.

Respiratory Care
|November 24, 2016
PubMed
Summary

A new definition for prolonged mechanical ventilation (PMV) in children is proposed, addressing variability in current criteria. This definition accounts for invasive and noninvasive ventilation, duration, and infant lung maturity.

Keywords:
childrencritical careintensive caremechanical ventilationneonatesprolonged mechanical ventilation

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Area of Science:

  • Pediatric critical care medicine
  • Neonatology
  • Respiratory therapy

Background:

  • The existing definition of prolonged mechanical ventilation (PMV) for adults lacks consensus in pediatric and neonatal populations.
  • This definitional gap leads to significant variability in studying PMV impact and outcomes in children.
  • A standardized definition is crucial for consistent research and clinical practice in pediatric respiratory care.

Purpose of the Study:

  • To review existing literature on pediatric and neonatal prolonged mechanical ventilation (PMV) definitions.
  • To identify key considerations for defining PMV in neonates and children.
  • To propose a standardized pediatric/neonatal adaptation of the adult PMV definition.

Main Methods:

  • Systematic literature search of electronic databases for studies describing PMV in children.
  • Extraction of definitional criteria from included studies.
  • Development of recommendations based on literature review and clinical expertise.

Main Results:

  • Analysis of 87 studies involving 34,255 subjects revealed diverse criteria for pediatric PMV.
  • Key variables included ventilation duration (6 hours to 3 months), inclusion of noninvasive ventilation (NIV), and consideration of weaning interruptions.
  • Chronological and postmenstrual age were identified as important factors for neonates.

Conclusions:

  • A proposed definition for pediatric PMV is: ≥ 21 consecutive days (after 37 weeks postmenstrual age) of ventilation for ≥ 6 hours/day.
  • This definition encompasses both invasive and noninvasive ventilation (NIV).
  • It includes short interruptions (< 48 hours) during weaning as part of the same ventilation episode, considering lung maturity.