Ventilator Liberation Practices in Pediatric Cardiac Critical Care

Area of Science:

• Pediatric Critical Care
• Cardiology
• Respiratory Medicine

Background:

• Mechanical ventilation is prevalent in critically ill children with cardiac disease.
• Limited literature exists on ventilator liberation practices for this specific pediatric population.
• Understanding current practices is crucial for improving patient outcomes.

Purpose of the Study:

• To describe current ventilator liberation practices in critically ill children with cardiac disease.
• To identify variations in extubation readiness testing and post-extubation support.
• To highlight areas for protocol development and quality improvement.

Main Methods:

• An electronic survey was distributed to pediatric ICU attending physicians within the Pediatric Cardiac Critical Care Consortium.
• The survey evaluated institutional protocols and individual practices regarding ventilator liberation, extubation readiness testing (ERT), spontaneous breathing trials (SBT), and post-extubation support.
• 133 responses from 47 hospitals were analyzed.

Main Results:

• Only 47% of institutions reported ERT eligibility screening and 55% reported SBT protocols.
• Most respondents utilized SBTs (95%) and pressure support augmentation to CPAP (92%) for extubation assessment.
• Significant variation was observed in extubation readiness parameters (e.g., pulse oximetry, lactate, pH, mixed venous saturation) and post-extubation non-invasive respiratory support (NRS) use.

Conclusions:

• Standardized ERT eligibility screening and SBT protocols are lacking in approximately half of surveyed institutions.
• Wide variations in extubation readiness assessment and post-extubation respiratory support strategies exist.
• There is a clear need for protocol development aligned with clinical guidelines and multi-center quality improvement to establish best practices for ventilator liberation in pediatric cardiac patients.