The Hospital for Sick Children, Department of Respiratory Therapy, Toronto, Ontario, Canada; McMaster University, School of Rehabilitation Sciences, Institute for Applied Health Sciences, Hamilton, Ontario, Canada; and Ontario Tech University, Faculty of Health Sciences, Oshawa, Ontario, Canada.
The Hospital for Sick Children, Department of Respiratory Therapy, Toronto, Ontario, Canada.
Respir Care. 2022 Nov;67(11):1420-1436. doi: 10.4187/respcare.09886. Epub 2022 Aug 3.
Pediatric mechanical ventilation practice guidelines are not well established; therefore, the European Society for Paediatric and Neonatal Intensive Care (ESPNIC) developed consensus recommendations on pediatric mechanical ventilation management in 2017. However, the guideline's applicability in different health care settings is unknown. This study aimed to determine the consensus on pediatric mechanical ventilation practices from Canadian respiratory therapists' (RTs) perspectives and consensually validate aspects of the ESPNIC guideline.
A 3-round modified electronic Delphi survey was conducted; contents were guided by ESPNIC. Participants were RTs with at least 5 years of experience working in standalone pediatric ICUs or units with dedicated pediatric intensive care beds across Canada. Round 1 collected open-text feedback, and subsequent rounds gathered feedback using a 6-point Likert scale. Consensus was defined as ≥ 75% agreement; if consensus was unmet, statements were revised for re-ranking in the subsequent round.
Fifty-two RTs from 14 different pediatric facilities participated in at least one of the 3 rounds. Rounds 1, 2, and 3 had a response rate of 80%, 93%, and 96%, respectively. A total of 59 practice statements achieved consensus by the end of round 3, categorized into 10 sections: (1) noninvasive ventilation and high-flow oxygen therapy, (2) tidal volume and inspiratory pressures, (3) breathing frequency and inspiratory times, (4) PEEP and F , (5) advanced modes of ventilation, (6) weaning, (7) physiological targets, (8) monitoring, (9) general, and (10) equipment adjuncts. Cumulative text feedback guided the formation of the clinical remarks to supplement these practice statements.
This was the first study to survey RTs for their perspectives on the general practice of pediatric mechanical ventilation management in Canada, generally aligning with the ESPNIC guideline. These practice statements considered information from health organizations and institutes, supplemented with clinical remarks. Future studies are necessary to verify and understand these practices' effectiveness.
儿科机械通气实践指南尚未得到很好的建立；因此，欧洲儿科和新生儿重症监护学会（ESPNIC）于 2017 年制定了儿科机械通气管理的共识建议。然而，该指南在不同医疗保健环境中的适用性尚不清楚。本研究旨在从加拿大呼吸治疗师（RTs）的角度确定儿科机械通气实践的共识，并对 ESPNIC 指南的各个方面进行一致性验证。
进行了三轮改良电子 Delphi 调查；内容由 ESPNIC 指导。参与者是在加拿大独立的儿科 ICU 或有专门儿科重症监护床位的单位工作至少 5 年的 RT。第一轮收集了开放式反馈，随后几轮使用 6 分制 Likert 量表收集反馈。共识定义为≥75%的一致；如果未达成共识，则对陈述进行修订，以便在下一轮重新排名。
来自 14 个不同儿科设施的 52 名 RT 参加了至少一轮调查。第 1、2 和 3 轮的回复率分别为 80%、93%和 96%。第 3 轮结束时，共有 59 项实践陈述达成共识，分为 10 个部分：（1）无创通气和高流量氧疗，（2）潮气量和吸气压力，（3）呼吸频率和吸气时间，（4）PEEP 和 F ，（5）高级通气模式，（6）撤机，（7）生理目标，（8）监测，（9）一般，和（10）设备辅助。累积文本反馈指导了临床注释的形成，以补充这些实践陈述。
这是第一项调查加拿大 RT 对儿科机械通气管理一般实践的看法的研究，与 ESPNIC 指南基本一致。这些实践陈述考虑了来自卫生组织和机构的信息，并辅以临床注释。需要进一步的研究来验证和了解这些实践的效果。
