The 2023 International Pediatric Ventilator Liberation Clinical Practice Guidelines provided evidence-based recommendations to guide pediatric critical care providers on how to perform daily aspects of ventilator liberation. However, because of the lack of high-quality pediatric studies, most recommendations were conditional based on very low to low certainty of evidence. What are the research gaps related to pediatric ventilator liberation that can be studied to strengthen the evidence for future updates of the guidelines? We conducted systematic reviews of the literature in eight predefined Population, Intervention, Comparator, Outcome (PICO) areas related to pediatric ventilator liberation to generate recommendations. Subgroups responsible for each PICO question subsequently identified major research gaps by synthesizing the literature. These gaps were presented at an international symposium at the Pediatric Acute Lung Injury and Sepsis Investigators meeting in spring 2022 for open discussion. Feedback was incorporated, and final evaluation of research gaps are summarized herein. Although randomized controlled trials (RCTs) represent the highest level of evidence, the panel sought to highlight areas where alternative study designs also may be appropriate, given challenges with conducting large multicenter RCTs in children. Significant research gaps were identified in six broad areas related to pediatric ventilator liberation. Several of these areas necessitate multicenter RCTs to provide definitive results, whereas other gaps can be addressed with multicenter observational studies or quality improvement initiatives. Furthermore, a need for some physiologic studies in several areas remains, particularly regarding newer diagnostic methods to improve identification of patients at high risk of extubation failure. Although pediatric ventilator liberation guidelines have been created, the certainty of evidence remains low and multiple research gaps exist that should be bridged through high-quality RCTs, multicenter observational studies, and quality improvement initiatives.

中文翻译：

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儿科呼吸机解放研究差距框架


2023 年国际儿科呼吸机解放临床实践指南提供了基于证据的建议，指导儿科重症监护提供者如何执行呼吸机解放的日常工作。然而，由于缺乏高质量的儿科研究，大多数建议都是基于极低至低质量证据的有条件的。与儿科呼吸机解放相关的研究差距有哪些，可以通过研究来加强指南未来更新的证据？我们对与儿科呼吸机解放相关的八个预先定义的人群、干预、比较、结果 (PICO) 领域的文献进行了系统回顾，以提出建议。负责每个 PICO 问题的小组随后通过综合文献确定了主要的研究差距。这些差距已在 2022 年春季儿科急性肺损伤和脓毒症研究人员会议的国际研讨会上提出，供公开讨论。本文纳入了反馈意见，并对研究差距进行了最终评估。尽管随机对照试验（RCT）代表了最高水平的证据，但考虑到在儿童中进行大型多中心随机对照试验的挑战，专家组试图强调替代研究设计也可能合适的领域。在与儿科呼吸机解放相关的六个广泛领域中发现了重大研究差距。其中一些领域需要多中心随机对照试验才能提供明确的结果，而其他差距可以通过多中心观察研究或质量改进举措来解决。 此外，仍然需要在几个领域进行一些生理学研究，特别是关于更新的诊断方法，以提高对拔管失败高风险患者的识别。尽管儿科呼吸机解放指南已经制定，但证据的质量仍然较低，并且存在多个研究空白，应通过高质量的随机对照试验、多中心观察性研究和质量改进举措来弥补。