AARC Clinical Practice Guideline: Spontaneous Breathing Trials for Liberation From Adult Mechanical Ventilation.

Autor: Roberts KJ; Thomas Jefferson University, Philadelphia, Pennsylvania karsten.roberts@jefferson.edu., Goodfellow LT; American Association for Respiratory Care/Daedalus Enterprises, Irving, Texas; and Georgia State University, Atlanta, Georgia., Battey-Muse CM; Georgia State University, Atlanta, Georgia., Hoerr CA; Phelps Health, Rolla, Missouri., Carreon ML; UT Health, San Antonio, Texas., Sorg ME; Boise State University, Boise, Idaho; and Bunnell, Inc, Salt Lake City, Utah., Glogowski J; Georgia State University, Atlanta, Georgia., Girard TD; Center for Research, Investigation, and Systems Modeling of Acute Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., MacIntyre NR; Duke University Medical Center, Durham, North Carolina., Hess DR; American Association for Respiratory Care/Daedalus Enterprises, Irving, Texas; and Massachusetts General Hospital, Boston, Massachusetts.
Jazyk: angličtina
Zdroj: Respiratory care [Respir Care] 2024 Jun 28; Vol. 69 (7), pp. 891-901. Date of Electronic Publication: 2024 Jun 28.
DOI: 10.4187/respcare.11735
Abstrakt: Despite prior publications of clinical practice guidelines related to ventilator liberation, some questions remain unanswered. Many of these questions relate to the details of bedside implementation. We, therefore, formed a guidelines committee of individuals with experience and knowledge of ventilator liberation as well as a medical librarian. Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, we make the following recommendations: (1) We suggest that calculation of a rapid shallow breathing index is not needed to determine readiness for a spontaneous breathing trial (SBT) (conditional recommendation; moderate certainty); (2) We suggest that SBTs can be conducted with or without pressure support ventilation (conditional recommendation, moderate certainty); (3) We suggest a standardized approach to assessment and, if appropriate, completion of an SBT before noon each day (conditional recommendation, very low certainty); and (4) We suggest that F IO 2 should not be increased during an SBT (conditional recommendation, very low certainty). These recommendations are intended to assist bedside clinicians to liberate adult critically ill patients more rapidly from mechanical ventilation.
Competing Interests: Dr Goodfellow discloses a relationship with the American Association for Respiratory Care/Daedalus Enterprises. Ms Sorg discloses a relationship with Bunnell. Dr Hess discloses relationships with Northeastern University, Lungpacer, Jones & Bartlett, McGraw Hill, UpToDate, and the University of Pittsburgh. Dr Girard discloses relationships with the National Institutes of Health, the US Department of Defense, Liberate Medical, Ceribell, and Lungpacer. Dr MacIntyre discloses relationship with InspiRx, Inogen, Philips, Baxter, Roch/Genentech, Vyaire, Encore, and Medtronic.
(Copyright © 2024 by Daedalus Enterprises.)
Databáze: MEDLINE
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