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Intensive Care Med. 2017 Dec;43(12):1764-1780. doi: 10.1007/s00134-017-4920-z. Epub 2017 Sep 22.

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

Author information

1
Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital Groningen, University Medical Center Groningen, The University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. m.c.j.kneyber@umcg.nl.
2
Critical Care, Anaesthesiology, Peri-operative and Emergency Medicine (CAPE), the University of Groningen, Groningen, The Netherlands. m.c.j.kneyber@umcg.nl.
3
Division of Pediatrics and Neonatal Critical Care, "A.Beclere" Medical Center, South Paris University Hospitals, APHP and South Paris-Saclay University, Paris, France.
4
Institute of Anesthesiology and Critical Care, Catholic University of the Sacred Heart, Rome, Italy.
5
Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
6
Service de Médecine et Réanimation néonatales de Port-Royal, Hôpital Cochin, Hôpitaux Universitaires Paris Centre and Paris Descartes University, Paris, France.
7
Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.
8
University Lyon 1, University of Lyon, Lyon, France.
9
Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, School of Medicine, Complutense University of Madrid, Madrid, Spain.
10
Gregorio Marañón Health Research Institute, Mother-Child Health and Development Network (Red SAMID) of Carlos III Health Institute, Madrid, Spain.
11
Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland.
12
Royal Brompton and Harefield NHS Trust, London, UK.
13
Department of Paediatrics, Division of Paediatric Critical Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
14
Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain.
15
Paediatric Intensive Care and Intermediate Care Department, Sant Joan de Déu Uni-versity Hospital, Universitat de Barcelona, Esplugues de Llobregat, Spain.
16
Critical Care Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.
17
Department of Anaesthesia and Intensive Care, Division of Paediatric Intensive Care Unit, Alessandria General Hospital, Alessandria, Italy.
18
Department of Pediatrics,Children's Hospital Traunstein, Ludwig Maximilians University Munich, Munich, Germany.
19
Department of Paediatrics, Division of Paediatric Emergency and Critical Care, Verona University Hospital, Verona, Italy.
20
Departments of Critical Care and Paediatric Bioethics, Great Ormond St Hospital for Children NHS Trust, London, UK.
21
Service of Neonatology and Pediatric Intensive Care, Department of Paediatrics, University Hospital of Geneva, Geneva, Switzerland.

Abstract

PURPOSE:

Much 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.

METHODS:

The 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.

RESULTS:

The 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.

CONCLUSIONS:

These 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.

KEYWORDS:

Lung disease; Mechanical ventilation; Paediatrics; Physiology

PMID:
28936698
PMCID:
PMC5717127
DOI:
10.1007/s00134-017-4920-z
[Indexed for MEDLINE]
Free PMC Article

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