TY - JOUR
T1 - Planning a Phased Guideline Implementation Strategy Across the Multicenter Ventilation Liberation for Kids (VentLib4Kids) Collaborative
AU - Ventilation Liberation for Kids (VentLib4Kids)
AU - Pediatric Respiratory and Ventilation Subgroup (PREVENT)
AU - Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)
AU - Loberger, Jeremy M.
AU - Hearld, Kristine R.
AU - Nishisaki, Akira
AU - Khemani, Robinder G.
AU - Steffen, Katherine M.
AU - Abu-Sultaneh, Samer
AU - Aljabari, Salim
AU - Al-Subu, Awni M.
AU - Bassi, Harjot K.
AU - Berkenbosch, John W.
AU - Berning, Eric L.
AU - Betters, Kristina A.
AU - Chadha, Mandeep S.
AU - Clark, Matthew G.
AU - Emeriaud, Guillaume
AU - Engorn, Branden M.
AU - Gaies, Michael
AU - Harvey, Helen A.
AU - Harwayne-Gidansky, Ilana
AU - Hummel, Kevin L.
AU - Keim, Garrett
AU - Kneyber, Martin
AU - Mastropietro, Christopher
AU - Miller, Andrew G.
AU - Napolitano, Natalie
AU - Page-Goertz, Christopher K.
AU - Romer, Amy
AU - Rotta, Alexandre T.
AU - Talukdar, Andrea
AU - Tzanetos, Deanna T.
AU - Ward, Shan
AU - Werho, David K.
AU - Webb, Lece V.
AU - White, Ben R.
AU - Zaccagni, Hayden
N1 - Publisher Copyright:
Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2025/3
Y1 - 2025/3
N2 - 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.
AB - 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.
KW - endotracheal extubation
KW - implementation science
KW - intensive care
KW - mechanical ventilator
KW - pediatrics
KW - quality improvement
UR - https://www.scopus.com/pages/publications/85213945133
U2 - 10.1097/PCC.0000000000003673
DO - 10.1097/PCC.0000000000003673
M3 - Article
C2 - 39699283
AN - SCOPUS:85213945133
SN - 1529-7535
VL - 26
SP - e396-e407
JO - Pediatric critical care medicine
JF - Pediatric critical care medicine
IS - 3
ER -