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

Timothy D. Girard, Waleed Alhazzani, John P. Kress, Daniel R. Ouellette, Gregory A. Schmidt, Jonathon D. Truwit, Suzanne M. Burns, Scott K. Epstein, Andres Esteban, Eddy Fan, Miguel Ferrer, Gilles L. Fraser, Michelle Ng Gong, Catherine L. Hough, Sangeeta Mehta, Rahul Nanchal, Sheena Patel, Amy J. Pawlik, William D. Schweickert, Curtis N. SesslerThomas Strøm, Kevin C. Wilson, Peter E. Morris

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)120-133
Number of pages14
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume195
Issue number1
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Mechanical Ventilators
Practice Guidelines
Artificial Respiration
Critical Illness
Rehabilitation
Guidelines
Early Ambulation
Respiratory Sounds
Steroids
Delivery of Health Care
Costs and Cost Analysis

ASJC Scopus subject areas

  • Medicine(all)
  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

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. / Girard, Timothy D.; Alhazzani, Waleed; Kress, John P.; Ouellette, Daniel R.; Schmidt, Gregory A.; Truwit, Jonathon D.; Burns, Suzanne M.; Epstein, Scott K.; Esteban, Andres; Fan, Eddy; Ferrer, Miguel; Fraser, Gilles L.; Gong, Michelle Ng; Hough, Catherine L.; Mehta, Sangeeta; Nanchal, Rahul; Patel, Sheena; Pawlik, Amy J.; Schweickert, William D.; Sessler, Curtis N.; Strøm, Thomas; Wilson, Kevin C.; Morris, Peter E.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 195, No. 1, 01.01.2017, p. 120-133.

Research output: Contribution to journalArticle

Girard, TD, Alhazzani, W, Kress, JP, Ouellette, DR, Schmidt, GA, Truwit, JD, Burns, SM, Epstein, SK, Esteban, A, Fan, E, Ferrer, M, Fraser, GL, Gong, MN, Hough, CL, Mehta, S, Nanchal, R, Patel, S, Pawlik, AJ, Schweickert, WD, Sessler, CN, Strøm, T, Wilson, KC & Morris, PE 2017, '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, no. 1, pp. 120-133.
Girard, Timothy D. ; Alhazzani, Waleed ; Kress, John P. ; Ouellette, Daniel R. ; Schmidt, Gregory A. ; Truwit, Jonathon D. ; Burns, Suzanne M. ; Epstein, Scott K. ; Esteban, Andres ; Fan, Eddy ; Ferrer, Miguel ; Fraser, Gilles L. ; Gong, Michelle Ng ; Hough, Catherine L. ; Mehta, Sangeeta ; Nanchal, Rahul ; Patel, Sheena ; Pawlik, Amy J. ; Schweickert, William D. ; Sessler, Curtis N. ; Strøm, Thomas ; Wilson, Kevin C. ; Morris, Peter E. / 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. In: American Journal of Respiratory and Critical Care Medicine. 2017 ; Vol. 195, No. 1. pp. 120-133.
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abstract = "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.",
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AU - Ouellette, Daniel R.

AU - Schmidt, Gregory A.

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AU - Epstein, Scott K.

AU - Esteban, Andres

AU - Fan, Eddy

AU - Ferrer, Miguel

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 - Schweickert, William D.

AU - Sessler, Curtis N.

AU - Strøm, Thomas

AU - Wilson, Kevin C.

AU - Morris, Peter E.

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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.

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