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
| Autor: | Andres Esteban, Curtis N. Sessler, Kevin C. Wilson, John P. Kress, Michelle Ng Gong, Waleed Alhazzani, Scott K. Epstein, Gregory A. Schmidt, Rahul Nanchal, Peter E. Morris, Eddy Fan, Amy J. Pawlik, Daniel R. Ouellette, Suzanne M. Burns, Catherine L. Hough, Jonathon D. Truwit, Sangeeta Mehta, Timothy D. Girard, William D. Schweickert, Miguel Ferrer, Gilles L. Fraser, Thomas Strøm, Sheena Patel |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Pulmonary and Respiratory Medicine Respiration Artificial/standards medicine.medical_specialty Critical Illness medicine.medical_treatment Psychological intervention MEDLINE Critical Care and Intensive Care Medicine Ventilator Weaning/standards 03 medical and health sciences 0302 clinical medicine Clinical Protocols Intubation Intratracheal medicine Humans Intensive care medicine Grading (education) Mechanical ventilation Rehabilitation business.industry Critically ill Clinical Protocols/standards 030208 emergency & critical care medicine Intubation Intratracheal/standards Guideline Respiration Artificial 030228 respiratory system Cuff business Ventilator Weaning Critical Illness/rehabilitation |
| Zdroj: | on behalf of the ATS/CHEST Ad Hoc Committee on Liberation from Mechanical Ventilation in Adults 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 . https://doi.org/10.1164/rccm.201610-2075ST Scopus-Elsevier |
| ISSN: | 1535-4970 1073-449X |
| DOI: | 10.1164/rccm.201610-2075st |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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