Liberation From Mechanical Ventilation in Critically Ill Adults: Executive Summary of an Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline

Gregory A. Schmidt, Timothy D. Girard, John P. Kress, Peter E. Morris, Daniel R. Ouellette, Waleed Alhazzani, 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, Jonathon D. Truwit

Research output: Contribution to journalArticle

16 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)160-165
Number of pages6
JournalChest
Volume151
Issue number1
DOIs
StatePublished - Jan 1 2017

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Practice Guidelines
Artificial Respiration
Critical Illness
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Critical Care
Medicine
Costs and Cost Analysis
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Population

Keywords

  • evidence-based medicine
  • guidelines
  • mechanical ventilation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Liberation From Mechanical Ventilation in Critically Ill Adults : Executive Summary of an Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline. / Schmidt, Gregory A.; Girard, Timothy D.; Kress, John P.; Morris, Peter E.; Ouellette, Daniel R.; Alhazzani, Waleed; 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.; Truwit, Jonathon D.

In: Chest, Vol. 151, No. 1, 01.01.2017, p. 160-165.

Research output: Contribution to journalArticle

Schmidt, GA, Girard, TD, Kress, JP, Morris, PE, Ouellette, DR, Alhazzani, W, 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 & Truwit, JD 2017, 'Liberation From Mechanical Ventilation in Critically Ill Adults: Executive Summary of an Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline', Chest, vol. 151, no. 1, pp. 160-165. https://doi.org/10.1016/j.chest.2016.10.037
Schmidt, Gregory A. ; Girard, Timothy D. ; Kress, John P. ; Morris, Peter E. ; Ouellette, Daniel R. ; Alhazzani, Waleed ; 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. ; Truwit, Jonathon D. / Liberation From Mechanical Ventilation in Critically Ill Adults : Executive Summary of an Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline. In: Chest. 2017 ; Vol. 151, No. 1. pp. 160-165.
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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.",
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AU - Kress, John P.

AU - Morris, Peter E.

AU - Ouellette, Daniel R.

AU - Alhazzani, Waleed

AU - Burns, Suzanne M.

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 - Truwit, Jonathon D.

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N2 - 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.

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