Implementing the Pediatric Ventilator Liberation Guidelines Using the Most Current Evidence: a Narrative Review.

Abstract

Invasive mechanical ventilation is prevalent and associated with significant morbidity. Pediatric critical care teams must identify the best timing and approach to liberating (extubating) children from this supportive care modality. Unsurprisingly, practice variation is significant. As a first step to minimizing that variation, the first evidence-based Pediatric Ventilator Liberation Guidelines were published in 2023 and included 15 recommendations. Unfortunately, there is often a substantial delay before clinical guidelines reach widespread clinical practice. As such, it is important to consider barriers and facilitators using a systematic approach during implementation planning and design. In this narrative review, we will 1) summarize guideline recommendations, 2) discuss recent evidence and identify practice gaps relating to those recommendations, and 3) hypothesize about potential barriers and facilitators to their implementation in clinical practice.