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 certainty in the evidence, and the feasibility and acceptability of various interventions. Recommendations were rated as strong or conditional. RESULTS: The guideline panel made four conditional recommendations 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.
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 certainty in the evidence, and the feasibility and acceptability of various interventions. Recommendations were rated as strong or conditional. RESULTS: The guideline panel made four conditional recommendations 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.
Authors: M Dietrich; C J Reuß; C Beynon; A Hecker; C Jungk; D Michalski; C Nusshag; K Schmidt; M Bernhard; T Brenner; M A Weigand Journal: Anaesthesist Date: 2019-11 Impact factor: 1.041
Authors: Jisha Joshua; Eric Scholten; Daniel Schaerer; Mahmood F Mafee; Thomas H Alexander; Laura E Crotty Alexander Journal: Ann Am Thorac Soc Date: 2018-06
Authors: Kazuya Kikutani; Shinichiro Ohshimo; Nobuaki Shime; Maria Del Mar Fernandez; Rafael Fernandez Journal: Intensive Care Med Date: 2018-02-21 Impact factor: 17.440
Authors: Stefannie Vorona; Umberto Sabatini; Sulaiman Al-Maqbali; Michele Bertoni; Martin Dres; Bernie Bissett; Frank Van Haren; A Daniel Martin; Cristian Urrea; Debbie Brace; Matteo Parotto; Margaret S Herridge; Neill K J Adhikari; Eddy Fan; Luana T Melo; W Darlene Reid; Laurent J Brochard; Niall D Ferguson; Ewan C Goligher Journal: Ann Am Thorac Soc Date: 2018-06
Authors: Reza Goharani; Amir Vahedian-Azimi; Iman H Galal; Leonardo Cordeiro de Souza; Behrooz Farzanegan; Farshid R Bashar; Michele Vitacca; Seyedpouzhia Shojaei; Seyed M M Mosavinasab; Shunsuke Takaki; Andrew C Miller Journal: J Thorac Dis Date: 2019-04 Impact factor: 2.895
Authors: Gavin D Perkins; Dipesh Mistry; Simon Gates; Fang Gao; Catherine Snelson; Nicholas Hart; Luigi Camporota; James Varley; Coralie Carle; Elankumaran Paramasivam; Beverley Hoddell; Daniel F McAuley; Timothy S Walsh; Bronagh Blackwood; Louise Rose; Sarah E Lamb; Stavros Petrou; Duncan Young; Ranjit Lall Journal: JAMA Date: 2018-11-13 Impact factor: 56.272