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A Delphi Survey of Canadian Respiratory Therapists' Practice Statements on Pediatric Mechanical Ventilation
Shirley Quach1, Katherine Reise2, Carolyn McGregor3
1The Hospital for Sick Children, Department of Respiratory Therapy, Toronto, Ontario, Canada; McMaster University, School of Rehabilitation Sciences, Institute for Applied Health Sciences, Hamilton, Ontario, Canada; and Ontario Tech University, Faculty of Health Sciences, Oshawa, Ontario, Canada.
Insights
Canadian respiratory therapists generally agree with European pediatric mechanical ventilation guidelines. This study established consensus on 59 practice statements for pediatric mechanical ventilation management in Canada.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Clinical Practice Guidelines
Background:
- Pediatric mechanical ventilation guidelines lack standardization.
- The European Society for Paediatric and Neonatal Intensive Care (ESPNIC) developed recommendations in 2017.
- The applicability of ESPNIC guidelines in diverse healthcare settings remains unclear.
Purpose of the Study:
- To assess Canadian respiratory therapists' consensus on pediatric mechanical ventilation practices.
- To validate aspects of the ESPNIC pediatric mechanical ventilation guideline from a Canadian perspective.
Main Methods:
- A 3-round modified electronic Delphi survey was employed.
- Participants included experienced respiratory therapists from Canadian pediatric intensive care units.
- Consensus was defined as ≥75% agreement, with iterative refinement of statements.
Main Results:
- Fifty-two respiratory therapists from 14 facilities participated.
- High response rates were achieved across all three rounds (80%-96%).
- Consensus was reached on 59 practice statements across 10 key areas of pediatric mechanical ventilation.
Conclusions:
- This study provides the first Canadian perspective on pediatric mechanical ventilation management.
- The findings largely align with the ESPNIC guideline.
- Further research is needed to confirm the effectiveness of these consensus-based practices.
Background:
Pediatric mechanical ventilation practice guidelines are not well established; therefore, the European Society for Paediatric and Neonatal Intensive Care (ESPNIC) developed consensus recommendations on pediatric mechanical ventilation management in 2017. However, the guideline's applicability in different health care settings is unknown. This study aimed to determine the consensus on pediatric mechanical ventilation practices from Canadian respiratory therapists' (RTs) perspectives and consensually validate aspects of the ESPNIC guideline.
Methods:
A 3-round modified electronic Delphi survey was conducted; contents were guided by ESPNIC. Participants were RTs with at least 5 years of experience working in standalone pediatric ICUs or units with dedicated pediatric intensive care beds across Canada. Round 1 collected open-text feedback, and subsequent rounds gathered feedback using a 6-point Likert scale. Consensus was defined as ≥ 75% agreement; if consensus was unmet, statements were revised for re-ranking in the subsequent round.
Results:
Fifty-two RTs from 14 different pediatric facilities participated in at least one of the 3 rounds. Rounds 1, 2, and 3 had a response rate of 80%, 93%, and 96%, respectively. A total of 59 practice statements achieved consensus by the end of round 3, categorized into 10 sections: (1) noninvasive ventilation and high-flow oxygen therapy, (2) tidal volume and inspiratory pressures, (3) breathing frequency and inspiratory times, (4) PEEP and FIO , (5) advanced modes of ventilation, (6) weaning, (7) physiological targets, (8) monitoring, (9) general, and (10) equipment adjuncts. Cumulative text feedback guided the formation of the clinical remarks to supplement these practice statements.
Conclusions:
This was the first study to survey RTs for their perspectives on the general practice of pediatric mechanical ventilation management in Canada, generally aligning with the ESPNIC guideline. These practice statements considered information from health organizations and institutes, supplemented with clinical remarks. Future studies are necessary to verify and understand these practices' effectiveness.
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