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Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation
Martin C J Kneyber1,2, Daniele de Luca3,4, Edoardo Calderini5
1Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital Groningen, University Medical Center Groningen, The University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. m.c.j.kneyber@umcg.nl.
Insights
This study established European consensus guidelines for paediatric mechanical ventilation, aiming to standardize care. The recommendations, developed by experts, will improve clinical practice and research for critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Clinical Guidelines
Background:
- Current paediatric mechanical ventilation practices often rely on anecdotal evidence and extrapolation from adult/neonatal data.
- This lack of standardized protocols hinders clinical trial design and interpretation in paediatric critical care.
- A European consensus is needed to establish evidence-based guidelines for mechanical ventilation in children.
Purpose:
Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children.
Methods:
The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms.
Results:
The Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with "strong agreement". The final iteration of the recommendations had none with equipoise or disagreement.
Conclusions:
These recommendations should help to harmonise the approach to paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research.
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