SCCMPod-553: Pediatric Ventilator Liberation: Challenges and Progress

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Maureen Madden, DNP, RN, CPNP-AC, CCRN, FCCM, speaks with Jeremy Loberger, MD, assistant professor of pediatrics and medical director of the pediatric intensive care unit at the University of Alabama at Birmingham. Dr. Loberger shares insights from his work as lead author of “Implementing the Pediatric Ventilator Liberation Guidelines Using the Most Current Evidence,” and co-principal investigator of the multicenter collaborative Ventilation Liberation for Kids (VentLib4Kids), aimed at standardizing and improving extubation practices.

Their conversation explores the evolving challenges of pediatric ventilator liberation, such as balancing extubation readiness with risks related to prolonged invasive mechanical ventilation and noninvasive respiratory support. Topics include the role of spontaneous breathing trials, pressure support strategies, sedation practices, and the impact of noninvasive modalities such as high-flow nasal cannula and bilevel positive airway pressure. They address the importance of individualized care, especially for high-risk patients such as children with neuromuscular disorders.

Dr. Loberger explains the quality improvement efforts under way that focus on implementing current clinical practice guidelines, standardizing practice, and aligning goals. Listeners will gain a deep understanding of the nuanced decision-making involved in ventilator liberation and collaborative efforts to improve outcomes for critically ill children.

Resources referenced in this episode:

• Implementing the Pediatric Ventilator Liberation Guidelines Using the Most Current Evidence (Loberger JM, et al. Respir Care. 2024;69:869-880)

• Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document (Abu-Sultaneh S, et al. Am J Respir Crit Care Med. 2023;207:17-28)