Gregory A Schmidt1, Timothy D Girard2, John P Kress3, Peter E Morris4, Daniel R Ouellette5, Waleed Alhazzani6, Suzanne M Burns7, Scott K Epstein8, Andres Esteban9, Eddy Fan10, Miguel Ferrer11, Gilles L Fraser12, Michelle Ng Gong13, Catherine L Hough14, Sangeeta Mehta15, Rahul Nanchal16, Sheena Patel17, Amy J Pawlik18, William D Schweickert19, Curtis N Sessler20, Thomas Strøm21, Kevin C Wilson22, Jonathon D Truwit23. 1. Division of Pulmonary, Critical Care & Occupational Medicine, University of Iowa, Iowa City, IA. 2. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 3. Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL. 4. Department of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY. 5. Department of Pulmonary Disease Service, Henry Ford Hospital, Detroit, MI. 6. Department of Medicine, McMaster University, Hamilton, ON, Canada. 7. Department of Nursing, University of Virginia Health System, Charlottesville, VA. 8. Division of Pulmonary, Critical Care and Sleep Medicine, Tufts University School of Medicine, Boston, MA. 9. Department of Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain. 10. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 11. Department of Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, CibeRes (CB06/06/0028), University of Barcelona, Barcelona, Spain. 12. Maine Medical Center, Portland, ME. 13. Departments of Medicine and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 14. Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA. 15. Division of Respirology, University of Toronto, Toronto, ON, Canada. 16. Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI. 17. American College of Chest Physicians, Glenview, IL. 18. Department of Therapy Services, University of Chicago Medical Center, Chicago, IL. 19. Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 20. Department of Internal Medicine, Division of Pulmonary and Critical Care, Virginia Commonwealth University School of Medicine, Richmond, VA. 21. Department of Anaesthesia and Intensive Care Medicine, University of Southern Denmark, Odense, Denmark. 22. Pulmonary, Allergy, Sleep and Critical Care Medicine, Boston University, Boston, MA. 23. Divison of Pulmonary and Critical Care Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI. Electronic address: jtruwit@mcw.edu.
Abstract
BACKGROUND: This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society (ATS) and the American College of Chest Physicians (CHEST). METHODS: A multidisciplinary panel posed six clinical questions in a population, intervention, comparator, outcomes (PICO) format. A comprehensive literature search and evidence synthesis was performed for each question, which included appraising the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The Evidence-to-Decision framework was applied to each question, requiring the panel to evaluate and weigh the importance of the problem, confidence in the evidence, certainty about how much the public values the main outcomes, magnitude and balance of desirable and undesirable outcomes, resources and costs associated with the intervention, impact on health disparities, and acceptability and feasibility of the intervention. RESULTS: Evidence-based recommendations were formulated and graded initially by subcommittees and then modified following full panel discussions. The recommendations were confirmed by confidential electronic voting; approval required that at least 80% of the panel members agree with the recommendation. CONCLUSIONS: The panel provides recommendations regarding liberation from mechanical ventilation. The details regarding the evidence and rationale for each recommendation are presented in the American Journal of Respiratory and Critical Care Medicine and CHEST.
BACKGROUND: This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society (ATS) and the American College of Chest Physicians (CHEST). METHODS: A multidisciplinary panel posed six clinical questions in a population, intervention, comparator, outcomes (PICO) format. A comprehensive literature search and evidence synthesis was performed for each question, which included appraising the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The Evidence-to-Decision framework was applied to each question, requiring the panel to evaluate and weigh the importance of the problem, confidence in the evidence, certainty about how much the public values the main outcomes, magnitude and balance of desirable and undesirable outcomes, resources and costs associated with the intervention, impact on health disparities, and acceptability and feasibility of the intervention. RESULTS: Evidence-based recommendations were formulated and graded initially by subcommittees and then modified following full panel discussions. The recommendations were confirmed by confidential electronic voting; approval required that at least 80% of the panel members agree with the recommendation. CONCLUSIONS: The panel provides recommendations regarding liberation from mechanical ventilation. The details regarding the evidence and rationale for each recommendation are presented in the American Journal of Respiratory and Critical Care Medicine and CHEST.
Authors: Carles Subirà; Gonzalo Hernández; Antònia Vázquez; Raquel Rodríguez-García; Alejandro González-Castro; Carolina García; Olga Rubio; Lara Ventura; Alexandra López; Maria-Carmen de la Torre; Elena Keough; Vanesa Arauzo; Cecilia Hermosa; Carmen Sánchez; Ana Tizón; Eva Tenza; César Laborda; Sara Cabañes; Victoria Lacueva; Maria Del Mar Fernández; Anna Arnau; Rafael Fernández Journal: JAMA Date: 2019-06-11 Impact factor: 56.272
Authors: Zhong-Hua Shi; Annemijn H Jonkman; Pieter Roel Tuinman; Guang-Qiang Chen; Ming Xu; Yan-Lin Yang; Leo M A Heunks; Jian-Xin Zhou Journal: Ann Transl Med Date: 2021-04
Authors: Kenneth E Remy; Philip A Verhoef; Jay R Malone; Michael D Ruppe; Timothy B Kaselitz; Frank Lodeserto; Eliotte L Hirshberg; Anthony Slonim; Cameron Dezfulian Journal: Pediatr Crit Care Med Date: 2020-07 Impact factor: 3.624