TY - JOUR
T1 - An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline
T2 - Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests
AU - Girard, Timothy D
AU - Alhazzani, Waleed
AU - Kress, John P
AU - Ouellette, Daniel R
AU - Schmidt, Gregory A
AU - Truwit, Jonathon D
AU - Burns, Suzanne M
AU - Epstein, Scott K
AU - Esteban, Andres
AU - Fan, Eddy
AU - Ferrer, Miquel
AU - Fraser, Gilles L
AU - Gong, Michelle Ng
AU - Hough, Catherine L
AU - Mehta, Sangeeta
AU - Nanchal, Rahul
AU - Patel, Sheena
AU - Pawlik, Amy J
AU - Sessler, Curtis N
AU - Strøm, Thomas
AU - Schweickert, William
AU - Wilson, Kevin C
AU - Morris, Peter E
AU - on behalf of the ATS/CHEST Ad Hoc Committee on Liberation from Mechanical Ventilation in Adults
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background: Interventions that lead to earlier liberation from mechanical ventilation can improve patient outcomes. This guideline, a collaborative effort between the American Thoracic Society and the American College of Chest Physicians, provides evidence-based recommendations to optimize liberation from mechanical ventilation in critically ill adults. Methods: Two methodologists performed evidence syntheses to summarize available evidence relevant to key questions about liberation from mechanical ventilation. The methodologists appraised the certainty in the evidence (i.e., the quality of evidence) using the Grading of Recommendations, Assessment, Development, and Evaluation approach and summarized the results in evidence profiles. The guideline panel then formulated recommendations after considering the balance of desirable consequences (benefits) versus undesirable consequences (burdens, adverse effects, and costs), the certaintyintheevidence,andthefeasibilityandacceptabilityofvarious interventions. Recommendations were rated as strong or conditional. Results:Theguidelinepanelmadefourconditionalrecommendations related to rehabilitation protocols, ventilator liberation protocols, and cuff leak tests. The recommendations were for acutely hospitalized adults mechanically ventilated for more than 24 hours to receive protocolized rehabilitation directed toward early mobilization, be managed with a ventilator liberation protocol, be assessed with a cuff leak test if they meet extubation criteria but are deemed high risk for postextubation stridor, and be administered systemic steroids for at least 4 hours before extubation if they fail the cuff leak test. Conclusions: The American Thoracic Society/American College of Chest Physicians recommendations are intended to support healthcare professionals in their decisions related to liberating critically ill adults from mechanical ventilation.
AB - Background: Interventions that lead to earlier liberation from mechanical ventilation can improve patient outcomes. This guideline, a collaborative effort between the American Thoracic Society and the American College of Chest Physicians, provides evidence-based recommendations to optimize liberation from mechanical ventilation in critically ill adults. Methods: Two methodologists performed evidence syntheses to summarize available evidence relevant to key questions about liberation from mechanical ventilation. The methodologists appraised the certainty in the evidence (i.e., the quality of evidence) using the Grading of Recommendations, Assessment, Development, and Evaluation approach and summarized the results in evidence profiles. The guideline panel then formulated recommendations after considering the balance of desirable consequences (benefits) versus undesirable consequences (burdens, adverse effects, and costs), the certaintyintheevidence,andthefeasibilityandacceptabilityofvarious interventions. Recommendations were rated as strong or conditional. Results:Theguidelinepanelmadefourconditionalrecommendations related to rehabilitation protocols, ventilator liberation protocols, and cuff leak tests. The recommendations were for acutely hospitalized adults mechanically ventilated for more than 24 hours to receive protocolized rehabilitation directed toward early mobilization, be managed with a ventilator liberation protocol, be assessed with a cuff leak test if they meet extubation criteria but are deemed high risk for postextubation stridor, and be administered systemic steroids for at least 4 hours before extubation if they fail the cuff leak test. Conclusions: The American Thoracic Society/American College of Chest Physicians recommendations are intended to support healthcare professionals in their decisions related to liberating critically ill adults from mechanical ventilation.
KW - Adult
KW - Clinical Protocols/standards
KW - Critical Illness/rehabilitation
KW - Humans
KW - Intubation, Intratracheal/standards
KW - Respiration, Artificial/standards
KW - Ventilator Weaning/standards
U2 - 10.1164/rccm.201610-2075ST
DO - 10.1164/rccm.201610-2075ST
M3 - Journal article
C2 - 27762595
SN - 1073-449X
VL - 195
SP - 120
EP - 133
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 1
ER -