RATIONALE Pediatric specific ventilator liberation guidelines are lacking despite the many studies exploring elements of extubation readiness testing. The lack of clinical practice guidelines has led to significant and unnecessary variation in methods used to assess pediatric patients' readiness for extubation. METHODS Twenty-six international experts comprised a multi-professional panel to establish pediatric specific ventilator liberation clinical practice guidelines, focusing on acutely hospitalized children receiving invasive mechanical ventilation for more than 24 hours. Eleven key questions were identified and first prioritized using the Modified Convergence of Opinion on Recommendations and Evidence. Systematic review was conducted for questions which did not meet an a-priori threshold of ≥80% agreement, with Grading of Recommendations, Assessment, Development, and Evaluation methodologies applied to develop the guidelines. The panel evaluated the evidence, drafted, and voted on the recommendations. MEASUREMENTS AND MAIN RESULTS Three questions related to systematic screening, using an extubation readiness testing bundle and use of a spontaneous breathing trial as part of the bundle met Modified Convergence of Opinion on Recommendations criteria of ≥80% agreement. For the remaining 8 questions, 5 systematic reviews yielded 12 recommendations related to the methods and duration of spontaneous breathing trials; measures of respiratory muscle strength; assessment of risk of post-extubation upper airway obstruction and its prevention; use of post-extubation non-invasive respiratory support; and sedation. Most recommendations were conditional and based on low to very low certainty of evidence. CONCLUSION This clinical practice guideline provides a conceptual framework with evidence-based recommendations for best practices related to pediatric ventilator liberation. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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执行摘要：国际儿科呼吸机解放临床实践指南，一份 PALISI 网络文件。

基本原理尽管许多研究探索了拔管准备测试的要素，但仍缺乏儿科特定的呼吸机解放指南。缺乏临床实践指南导致用于评估儿科患者拔管准备情况的方法出现重大和不必要的变化。方法 26 位国际专家组成一个多专业小组，制定儿科特定呼吸机解放临床实践指南，重点关注接受有创机械通气超过 24 小时的急性住院儿童。使用修改后的建议和证据意见趋同，确定了 11 个关键问题并首先确定了优先级。对不符合 ≥80% 一致的先验阈值的问题进行系统审查，并对建议进行分级，用于制定指南的评估、开发和评估方法。专家组评估了证据，起草了建议，并对建议进行了投票。测量和主要结果 与系统筛查相关的三个问题、使用拔管准备测试捆绑包和使用自主呼吸试验作为捆绑包的一部分符合 ≥80% 一致的推荐标准的修正意见收敛。对于其余 8 个问题，5 篇系统评价提出了 12 条与自主呼吸试验的方法和持续时间相关的建议；呼吸肌力量的测量；评估拔管后上呼吸道阻塞的风险及其预防；使用拔管后无创呼吸支持；和镇静。大多数建议是有条件的，并且基于低到非常低的证据质量。结论 本临床实践指南提供了一个概念框架，其中包含有关儿科呼吸机解放的最佳实践的循证建议。本文是开放获取并根据知识共享署名非商业性无衍生许可 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/) 的条款分发。