title: Pediatric Prolonged Mechanical Ventilation: Considerations for Definitional Criteria.
abstract: BACKGROUND
  A 2005 consensus conference led by the National Association for Medical Direction of Respiratory Care (NAMDRC) defined prolonged mechanical ventilation (PMV) for adults as invasive and/or noninvasive mechanical ventilation (NIV) for ≥ 21 consecutive days for ≥ 6 h/d. In children, no such consensus definition exists. This results in substantial variability in definitional criteria, making study of the impact and outcomes of PMV across and within settings problematic. The objective of this work was to identify how PMV for children and neonates is described in the literature and to outline pediatric/neonatal considerations related to PMV, with the goal of proposing a pediatric/neonatal adaptation to the NAMDRC definition.
  
  
  METHODS
  We searched electronic databases for studies describing PMV in children. We extracted definitional criteria and developed recommendations based on the literature review and our clinical experience.
  
  
  RESULTS
  Of the 416 citations obtained, 87 met inclusion criteria, totaling 34,255 subjects. Identified criteria for the pediatric PMV definition included: number of consecutive days of mechanical ventilation (ranging from 6 h to 3 months), inclusion of NIV, time spent off the ventilator during weaning (considered as same ventilation episode), and importance of chronological age (term neonates) and postmenstrual age for preterm neonates. We considered high-flow nasal cannula; however, we determined that its current role as a weaning adjunct is unclear.
  
  
  CONCLUSIONS
  Therefore, we developed the following recommendations for the pediatric PMV definition: ≥ 21 consecutive days (after 37 weeks postmenstrual age) of ventilation for ≥ 6 h/d considering invasive ventilation and NIV and including short interruptions (< 48 h) of ventilation during the weaning process as the same episode of ventilation. We propose a definition of pediatric PMV that incorporates the number of consecutive days of mechanical ventilation while taking into account use of NIV and lung maturity and including short interruptions during the weaning process.
authors.affiliation: Research Center of Sainte-Justine Hospital and the Pediatric ICU, Sainte-Justine Hospital, Montreal, Québec, Canada.
authors.forename: Michaël
authors.initials: M
authors.lastname: Sauthier
authors.affiliation: Department of Critical Care, Sunnybrook Health Sciences Centre, the Sunnybrook Research Institute, the Lawrence S Bloomberg Faculty of Nursing and Interdepartmental Division of Critical Care Medicine, University of Toronto, the Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
authors.affiliation: Research Center of Sainte-Justine Hospital and the Pediatric ICU, Sainte-Justine Hospital, Montreal, Québec, Canada. philippe.jouvet@umontreal.ca.
authors.forename: Philippe
authors.initials: P
authors.lastname: Jouvet
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D063087:Noninvasive Ventilation; D012121:Respiration, Artificial; D009626:Terminology as Topic; D013997:Time Factors; D015300:Ventilator Weaning
keywords: children; critical care; intensive care; mechanical ventilation; neonates; prolonged mechanical ventilation