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Operational Definitions Related to Pediatric Ventilator Liberation
Samer Abu-Sultaneh1, Narayan Prabhu Iyer2, Analía Fernández3
1Division of Pediatric Critical Care, Department of Pediatrics Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN.
Insights
Operational definitions for pediatric ventilator liberation were established by expert consensus. These consensus-based definitions will improve research generalizability and facilitate comparisons in quality improvement initiatives.
Area of Science:
- Pediatric critical care medicine
- Respiratory therapy
- Clinical research methodology
Background:
- Standardized operational definitions are essential for assessing interventions and outcomes in pediatric mechanical ventilation.
- Current variability in definitions hinders research generalizability and the establishment of best practices.
- This study aimed to establish consensus-based definitions for pediatric ventilator liberation.
Framework:
- A systematic literature review was conducted by experts across eight key topic areas related to pediatric ventilator liberation.
- A consensus-based approach involving multiple rounds of virtual meetings and anonymous voting was employed.
- Methodologists and librarians supported the systematic review and consensus-building process.
Implementation:
- 16 preliminary definitions were developed across eight topic areas.
- Definitions were iteratively refined based on expert discussions, systematic review data, and two rounds of anonymous voting.
- A ≥80% agreement threshold was achieved for all 16 final definitions.
Implications:
- Consensus-based definitions were established for critical elements including respiratory support, liberation attempts, ventilator-free days, and spontaneous breathing trials.
- These evidence-informed definitions are proposed for use in future quality improvement initiatives and research studies.
- Adoption of these definitions will enhance the generalizability and comparability of findings in pediatric ventilator liberation.
Background:
Common, operational definitions are crucial to assess interventions and outcomes related to pediatric mechanical ventilation. These definitions can reduce unnecessary variability among research and quality improvement efforts, to ensure findings are generalizable, and can be pooled to establish best practices.
Research Question:
Can we establish operational definitions for key elements related to pediatric ventilator liberation using a combination of detailed literature review and consensus-based approaches?
Study Design And Methods:
A panel of 26 international experts in pediatric ventilator liberation, two methodologists, and two librarians conducted systematic reviews on eight topic areas related to pediatric ventilator liberation. Through a series of virtual meetings, we established draft definitions that were voted upon using an anonymous web-based process. Definitions were revised by incorporating extracted data gathered during the systematic review and discussed in another consensus meeting. A second round of voting was conducted to confirm the final definitions.
Results:
In eight topic areas identified by the experts, 16 preliminary definitions were established. Based on initial discussion and the first round of voting, modifications were suggested for 11 of the 16 definitions. There was significant variability in how these items were defined in the literature reviewed. The final round of voting achieved ≥ 80% agreement for all 16 definitions in the following areas: what constitutes respiratory support (invasive mechanical ventilation and noninvasive respiratory support), liberation and failed attempts to liberate from invasive mechanical ventilation, liberation from respiratory support, duration of noninvasive respiratory support, total duration of invasive mechanical ventilation, spontaneous breathing trials, extubation readiness testing, 28 ventilator-free days, and planned vs rescue use of post-extubation noninvasive respiratory support.
Interpretation:
We propose that these consensus-based definitions for elements of pediatric ventilator liberation, informed by evidence, be used for future quality improvement initiatives and research studies to improve generalizability and facilitate comparison.
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