Journal article
Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline
Chest, Vol.151(1), pp.166-180
01/01/2017
DOI: 10.1016/j.chest.2016.10.036
PMID: 27818331
Abstract
An update of evidence-based guidelines concerning liberation from mechanical ventilation is needed as new evidence has become available. The American College of Chest Physicians (CHEST) and the American Thoracic Society (ATS) have collaborated to provide recommendations to clinicians concerning liberation from the ventilator.
Comprehensive evidence syntheses, including meta-analyses, were performed to summarize all available evidence relevant to the guideline panel’s questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, and the results were summarized in evidence profiles. The evidence syntheses were discussed and recommendations developed and approved by a multidisciplinary committee of experts in mechanical ventilation.
Recommendations for three population, intervention, comparator, outcome (PICO) questions concerning ventilator liberation are presented in this document. The guideline panel considered the balance of desirable (benefits) and undesirable (burdens, adverse effects, costs) consequences, quality of evidence, feasibility, and acceptability of various interventions with respect to the selected questions. Conditional (weak) recommendations were made to use inspiratory pressure augmentation in the initial spontaneous breathing trial (SBT) and to use protocols to minimize sedation for patients ventilated for more than 24 h. A strong recommendation was made to use preventive noninvasive ventilation (NIV) for high-risk patients ventilated for more than 24 h immediately after extubation to improve selected outcomes. The recommendations were limited by the quality of the available evidence.
The guideline panel provided recommendations for inspiratory pressure augmentation during an initial SBT, protocols minimizing sedation, and preventative NIV, in relation to ventilator liberation.
Details
- Title: Subtitle
- Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline
- Creators
- Daniel R. Ouellette - Henry Ford HospitalSheena Patel - University of PittsburghTimothy D. Girard - University of PittsburghPeter E. Morris - University of KentuckyGregory A. Schmidt - University of Iowa, Pulmonary, Critical Care, and Occupational MedicineJonathon D. Truwit - Medical College of WisconsinWaleed Alhazzani - McMaster UniversitySuzanne M. Burns - University of Virginia Health System, Charlottesville, VAScott K. Epstein - Division of Pulmonary, Critical Care and Sleep Medicine, Tufts University School of Medicine, Boston, MAAndres Esteban - Hospital Universitario de GetafeEddy Fan - University of TorontoMiguel Ferrer - Department of Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, CibeRes (CB06/06/0028), University of Barcelona, Barcelona, SpainGilles L. Fraser - Maine Medical Center, Portland, MEMichelle Ng Gong - Albert Einstein College of MedicineCatherine L. Hough - University of WashingtonSangeeta Mehta - University of TorontoRahul Nanchal - Medical College of WisconsinAmy J. Pawlik - Department of Therapy Services, University of Chicago Medical Center, Chicago, ILWilliam D. Schweickert - University of PennsylvaniaCurtis N. Sessler - Virginia Commonwealth UniversityThomas Strøm - University of Southern DenmarkJohn P. Kress - University of Chicago
- Resource Type
- Journal article
- Publication Details
- Chest, Vol.151(1), pp.166-180
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.chest.2016.10.036
- PMID
- 27818331
- ISSN
- 0012-3692
- eISSN
- 1931-3543
- Language
- English
- Date published
- 01/01/2017
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984472850602771
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