Multicenter Study

. 2025 Mar 1;26(3):e396-e407.

doi: 10.1097/PCC.0000000000003673. Epub 2024 Dec 19.

Planning a Phased Guideline Implementation Strategy Across the Multicenter Ventilation Liberation for Kids (VentLib4Kids) Collaborative

Jeremy M Loberger¹, Kristine R Hearld², Akira Nishisaki³, Robinder G Khemani⁴, Katherine M Steffen⁵, Samer Abu-Sultaneh⁶; Ventilation Liberation for Kids (VentLib4Kids) Investigators on behalf of the Pediatric Respiratory and Ventilation Subgroup (PREVENT) of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network

Collaborators, Affiliations

Collaborators

Ventilation Liberation for Kids (VentLib4Kids) Investigators on behalf of the Pediatric Respiratory and Ventilation Subgroup (PREVENT) of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network:
Salim Aljabari⁷, Awni M Al-Subu⁸, Harjot K Bassi⁹, John W Berkenbosch¹⁰, Eric L Berning¹¹, Kristina A Betters¹², Mandeep S Chadha¹³, Matthew G Clark¹⁴, Guillaume Emeriaud¹⁵, Branden M Engorn¹⁶, Michael Gaies¹⁷, Helen A Harvey¹⁸, Ilana Harwayne-Gidansky¹⁹, Kevin L Hummel²⁰, Garrett Keim³, Martin Kneyber²¹, Christopher Mastropietro⁶, Andrew G Miller²², Natalie Napolitano²³, Christopher K Page-Goertz²⁴, Amy Romer²⁵, Alexandre T Rotta²⁶, Andrea Talukdar²⁷, Deanna T Tzanetos²⁸, Shan Ward²⁹, David K Werho⁹, Lece V Webb¹, Ben R White²⁰, Hayden Zaccagni³⁰

Affiliations

¹ Division of Pediatric Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
² Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL.
³ Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
⁴ Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA.
⁵ Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
⁶ Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana, University Health and Indiana University School of Medicine, Indianapolis, IN.
⁷ Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR).
⁸ Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
⁹ Division of Pediatric Cardiology, University of California San Diego, San Diego, CA.
¹⁰ Division of Pediatric Critical Care Medicine, University of Louisville School of Medicine, "Just For Kids" Critical Care Center, Norton Children's Hospital, Louisville, KY.
¹¹ Division of Pediatric Critical Care, Prisma Health Children's Hospital Upstate, Greenville, SC.
¹² Monroe Carrell Jr. Children's Hospital at Vanderbilt, Vanderbilt University, Nashville, TN.
¹³ University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA.
¹⁴ Cardiac Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
¹⁵ Department of Pediatrics, CHU Sainte Justine, Université de Montréal, Montreal, QC, Canada.
¹⁶ Departments of Anesthesiology and Critical Care Medicine, Rady Children's Hospital San Diego, San Diego, CA.
¹⁷ The Heart Institute, Cincinnati Children's Hospital, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
¹⁸ Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of California, San Diego, Rady Children's Hospital, San Diego, CA.
¹⁹ Department of Pediatrics, Division of Pediatric Critical Care Medicine, Albany Medical College, Albany, NY.
²⁰ Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Utah, Salt Lake City, UT.
²¹ Department of Pediatrics, Division of Pediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²² Respiratory Care Services, Duke University Medical Center, Durham, NC.
²³ Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA.
²⁴ Department of Pediatrics, Division of Critical Care Medicine, Akron Children's Hospital, Akron, OH.
²⁵ Department of Anesthesiology and Critical Care, Division of Cardiac Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
²⁶ Division of Pediatric Critical Care Medicine, Duke University School of Medicine, Durham, NC.
²⁷ Children's Nebraska, University of Nebraska Medical Center, Omaha, NE.
²⁸ Department of Pediatrics, Division of Pediatric Critical Care Medicine, Norton Children's Hospital, University of Louisville, Louisville, KY.
²⁹ Department of Pediatrics, Division of Critical Care, UCSF Benioff Children's Hospitals, San Francisco and Oakland, CA.
³⁰ Division of Cardiology, Children's Medical Center, University of Texas Southwestern, Dallas, TX.

PMID: 39699283
DOI: 10.1097/PCC.0000000000003673

Multicenter Study

Planning a Phased Guideline Implementation Strategy Across the Multicenter Ventilation Liberation for Kids (VentLib4Kids) Collaborative

Jeremy M Loberger et al. Pediatr Crit Care Med. 2025.

. 2025 Mar 1;26(3):e396-e407.

doi: 10.1097/PCC.0000000000003673. Epub 2024 Dec 19.

Authors

Collaborators

Ventilation Liberation for Kids (VentLib4Kids) Investigators on behalf of the Pediatric Respiratory and Ventilation Subgroup (PREVENT) of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network:
Salim Aljabari⁷, Awni M Al-Subu⁸, Harjot K Bassi⁹, John W Berkenbosch¹⁰, Eric L Berning¹¹, Kristina A Betters¹², Mandeep S Chadha¹³, Matthew G Clark¹⁴, Guillaume Emeriaud¹⁵, Branden M Engorn¹⁶, Michael Gaies¹⁷, Helen A Harvey¹⁸, Ilana Harwayne-Gidansky¹⁹, Kevin L Hummel²⁰, Garrett Keim³, Martin Kneyber²¹, Christopher Mastropietro⁶, Andrew G Miller²², Natalie Napolitano²³, Christopher K Page-Goertz²⁴, Amy Romer²⁵, Alexandre T Rotta²⁶, Andrea Talukdar²⁷, Deanna T Tzanetos²⁸, Shan Ward²⁹, David K Werho⁹, Lece V Webb¹, Ben R White²⁰, Hayden Zaccagni³⁰

Affiliations

¹ Division of Pediatric Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
² Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL.
³ Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
⁴ Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA.
⁵ Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
⁶ Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana, University Health and Indiana University School of Medicine, Indianapolis, IN.
⁷ Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR).
⁸ Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
⁹ Division of Pediatric Cardiology, University of California San Diego, San Diego, CA.
¹⁰ Division of Pediatric Critical Care Medicine, University of Louisville School of Medicine, "Just For Kids" Critical Care Center, Norton Children's Hospital, Louisville, KY.
¹¹ Division of Pediatric Critical Care, Prisma Health Children's Hospital Upstate, Greenville, SC.
¹² Monroe Carrell Jr. Children's Hospital at Vanderbilt, Vanderbilt University, Nashville, TN.
¹³ University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA.
¹⁴ Cardiac Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
¹⁵ Department of Pediatrics, CHU Sainte Justine, Université de Montréal, Montreal, QC, Canada.
¹⁶ Departments of Anesthesiology and Critical Care Medicine, Rady Children's Hospital San Diego, San Diego, CA.
¹⁷ The Heart Institute, Cincinnati Children's Hospital, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
¹⁸ Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of California, San Diego, Rady Children's Hospital, San Diego, CA.
¹⁹ Department of Pediatrics, Division of Pediatric Critical Care Medicine, Albany Medical College, Albany, NY.
²⁰ Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Utah, Salt Lake City, UT.
²¹ Department of Pediatrics, Division of Pediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²² Respiratory Care Services, Duke University Medical Center, Durham, NC.
²³ Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA.
²⁴ Department of Pediatrics, Division of Critical Care Medicine, Akron Children's Hospital, Akron, OH.
²⁵ Department of Anesthesiology and Critical Care, Division of Cardiac Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
²⁶ Division of Pediatric Critical Care Medicine, Duke University School of Medicine, Durham, NC.
²⁷ Children's Nebraska, University of Nebraska Medical Center, Omaha, NE.
²⁸ Department of Pediatrics, Division of Pediatric Critical Care Medicine, Norton Children's Hospital, University of Louisville, Louisville, KY.
²⁹ Department of Pediatrics, Division of Critical Care, UCSF Benioff Children's Hospitals, San Francisco and Oakland, CA.
³⁰ Division of Cardiology, Children's Medical Center, University of Texas Southwestern, Dallas, TX.

PMID: 39699283
DOI: 10.1097/PCC.0000000000003673

Abstract

Objectives: To evaluate contextual factors relevant to implementing pediatric ventilator liberation guidelines and to develop an implementation strategy for a multicenter collaborative.

Design: Cross-sectional qualitative analysis of a 2023/2024 survey.

Setting: International, multicenter Ventilation Liberation for Kids (VentLib4Kids) collaborative.

Subjects: Physicians, advanced practice providers, respiratory therapists, and nurses.

Interventions: None.

Measurements and main results: The survey was distributed to 26 PICUs representing 18 unique centers (17 in North American)-14 general medical/surgical, eight cardiac, and four mixed (1935 solicitations). All 409 responses were analyzed (prescribers 39.8%, nursing 32.8%, and respiratory therapists 27.4%). Three implementation tiers were identified based on perceptions of evidence, feasibility, positive impact, and favorability constructs. Tier A (≥ 80% agreement for all constructs) included extubation readiness testing (ERT) screening, ERT bundle, spontaneous breathing trials (SBTs), upper airway obstruction (UAO) risk mitigation, and risk stratified noninvasive respiratory support (NRS). Tier B (50-79% agreement) included standard risk SBT method, risk stratified SBT duration, and UAO risk assessment. Tier C (< 50% agreement) included high-risk SBT method, respiratory muscle strength testing, and infant NRS. The smallest perceived practice gaps were noted in tier A and the largest in tier C. The smallest practice gap was risk stratified NRS (88% agreement). The largest practice gap was respiratory muscle strength (18% agreement). In regression analysis, independently significant differences in perceptions based on role and unit type for multiple constructs were identified for UAO risk assessment, UAO risk mitigation, risk stratified NRS, and infant NRS.

Conclusions: This survey study of the VentLib4Kids collaborative lays the foundation for phased implementation of the 2023 pediatric ventilator liberation guidelines. Early phases should focus on the best implementation profiles and smallest practice gaps. Later phases should address those that are more challenging. Unit- and role-based tailoring of differences should be considered for some recommendations more than others.

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Conflict of interest statement

Dr. Nishisaki’s institution received funding from the National Institutes of Health, the Agency for Healthcare Research and Quality, and Chiesi. Dr. Khemani received funding from OrangeMed Nihon Kohden and Bayer Pharmaceuticals. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

1. Abu-Sultaneh S, Iyer NP, Fernández A, et al.: Executive summary: International clinical practice guidelines for pediatric ventilator liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network document. Am J Respir Crit Care Med. 2023; 207:17–28
1. Abu-Sultaneh S, Iyer NP, Fernández A, et al.; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network: Operational definitions related to pediatric ventilator liberation. Chest. 2023; 163:1130–1143
1. Iyer NP, López-Fernández YM, González-Dambrauskas S, et al.: A network meta-analysis of dexamethasone for preventing postextubation upper airway obstruction in children. Ann Am Thorac Soc. 2023; 20:118–130
1. Iyer NP, Rotta AT, Essouri S, et al.: Association of extubation failure rates with high-flow nasal cannula, continuous positive airway pressure, and bilevel positive airway pressure vs conventional oxygen therapy in infants and young children: A systematic review and network meta-analysis. JAMA Pediatr. 2023; 177:774–781
1. Loberger JM, Campbell CM, Colleti J Jr, et al.: Ventilation liberation practices among 380 international PICUs. Crit Care Explor. 2022; 4:e0710

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Planning a Phased Guideline Implementation Strategy Across the Multicenter Ventilation Liberation for Kids (VentLib4Kids) Collaborative

Collaborators

Affiliations

Planning a Phased Guideline Implementation Strategy Across the Multicenter Ventilation Liberation for Kids (VentLib4Kids) Collaborative

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous