Journal article
An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests
American journal of respiratory and critical care medicine, Vol.195(1), pp.120-133
01/01/2017
DOI: 10.1164/rccm.201610-2075ST
PMID: 27762595
Abstract
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.
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.
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.
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.
Details
- Title: Subtitle
- An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests
- Creators
- Timothy D GirardWaleed AlhazzaniJohn P KressDaniel R OuelletteGregory A SchmidtJonathon D TruwitSuzanne M BurnsScott K EpsteinAndres EstebanEddy FanMiguel FerrerGilles L FraserMichelle Ng GongCatherine L HoughSangeeta MehtaRahul NanchalSheena PatelAmy J PawlikWilliam D SchweickertCurtis N SesslerThomas StrømKevin C WilsonPeter E MorrisATS/CHEST Ad Hoc Committee on Liberation from Mechanical Ventilation in Adults
- Resource Type
- Journal article
- Publication Details
- American journal of respiratory and critical care medicine, Vol.195(1), pp.120-133
- DOI
- 10.1164/rccm.201610-2075ST
- PMID
- 27762595
- ISSN
- 1073-449X
- eISSN
- 1535-4970
- Language
- English
- Date published
- 01/01/2017
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984094624602771
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