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Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC)

Authors
  • Kneyber, Martin C. J.1, 2
  • de Luca, Daniele3, 4
  • Calderini, Edoardo5
  • Jarreau, Pierre-Henri6
  • Javouhey, Etienne7, 8
  • Lopez-Herce, Jesus9, 10
  • Hammer, Jürg11
  • Macrae, Duncan12
  • Markhorst, Dick G.13
  • Medina, Alberto14
  • Pons-Odena, Marti15, 16
  • Racca, Fabrizio17
  • Wolf, Gerhard18
  • Biban, Paolo19
  • Brierley, Joe20
  • Rimensberger, Peter C.21
  • 1 The University of Groningen, Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children’s Hospital Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands , Groningen (Netherlands)
  • 2 the University of Groningen, Critical Care, Anaesthesiology, Peri–operative and Emergency Medicine (CAPE), Groningen, The Netherlands , Groningen (Netherlands)
  • 3 APHP and South Paris-Saclay University, Division of Pediatrics and Neonatal Critical Care, “A.Beclere” Medical Center, South Paris University Hospitals, Paris, France , Paris (France)
  • 4 Catholic University of the Sacred Heart, Institute of Anesthesiology and Critical Care, Rome, Italy , Rome (Italy)
  • 5 Ospedale Maggiore Policlinico, Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda, Milan, Italy , Milan (Italy)
  • 6 Hôpitaux Universitaires Paris Centre and Paris Descartes University, Service de Médecine et Réanimation néonatales de Port-Royal, Hôpital Cochin, Paris, France , Paris (France)
  • 7 Hospices Civils de Lyon, Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Lyon, France , Lyon (France)
  • 8 University of Lyon, University Lyon 1, Lyon, France , Lyon (France)
  • 9 Complutense University of Madrid, Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, School of Medicine, Madrid, Spain , Madrid (Spain)
  • 10 Gregorio Marañón Health Research Institute, Mother–Child Health and Development Network (Red SAMID) of Carlos III Health Institute, Madrid, Spain , Madrid (Spain)
  • 11 University of Basel, Division of Respiratory and Critical Care Medicine, University Children’s Hospital Basel, Basel, Switzerland , Basel (Switzerland)
  • 12 Royal Brompton and Harefield NHS Trust, London, UK , London (United Kingdom)
  • 13 VU University Medical Center, Department of Paediatrics, Division of Paediatric Critical Care Medicine, Amsterdam, The Netherlands , Amsterdam (Netherlands)
  • 14 Hospital Universitario Central de Asturias, Paediatric Intensive Care Unit, Oviedo, Spain , Oviedo (Spain)
  • 15 Universitat de Barcelona, Paediatric Intensive Care and Intermediate Care Department, Sant Joan de Déu Uni-versity Hospital, Esplugues de Llobregat, Spain , Esplugues de Llobregat (Spain)
  • 16 Institut de Recerca Sant Joan de Déu, Critical Care Research Group, Santa Rosa 39-57, Esplugues de Llobregat, 08950, Spain , Esplugues de Llobregat (Spain)
  • 17 Alessandria General Hospital, Department of Anaesthesia and Intensive Care, Division of Paediatric Intensive Care Unit, Alessandria, Italy , Alessandria (Italy)
  • 18 Ludwig Maximilians University Munich, Department of Pediatrics,Children’s Hospital Traunstein, Munich, Germany , Munich (Germany)
  • 19 Verona University Hospital, Department of Paediatrics, Division of Paediatric Emergency and Critical Care, Verona, Italy , Verona (Italy)
  • 20 Great Ormond St Hospital for Children NHS Trust, Departments of Critical Care and Paediatric Bioethics, London, UK , London (United Kingdom)
  • 21 University Hospital of Geneva, Service of Neonatology and Pediatric Intensive Care, Department of Paediatrics, Geneva, Switzerland , Geneva (Switzerland)
Type
Published Article
Journal
Intensive Care Medicine
Publisher
Springer Berlin Heidelberg
Publication Date
Sep 22, 2017
Volume
43
Issue
12
Pages
1764–1780
Identifiers
DOI: 10.1007/s00134-017-4920-z
Source
Springer Nature
Keywords
License
Green

Abstract

PurposeMuch of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children.MethodsThe European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms.ResultsThe Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with “strong agreement”. The final iteration of the recommendations had none with equipoise or disagreement.ConclusionsThese recommendations should help to harmonise the approach to paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research.

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