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

doi:10.1016/j.chest.2016.10.037

Practice Guideline

. 2017 Jan;151(1):160-165.

doi: 10.1016/j.chest.2016.10.037. Epub 2016 Nov 3.

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 Schmidt¹, Timothy D Girard², John P Kress³, Peter E Morris⁴, Daniel R Ouellette⁵, Waleed Alhazzani⁶, Suzanne M Burns⁷, Scott K Epstein⁸, Andres Esteban⁹, Eddy Fan¹⁰, Miguel Ferrer¹¹, Gilles L Fraser¹², Michelle Ng Gong¹³, Catherine L Hough¹⁴, Sangeeta Mehta¹⁵, Rahul Nanchal¹⁶, Sheena Patel¹⁷, Amy J Pawlik¹⁸, William D Schweickert¹⁹, Curtis N Sessler²⁰, Thomas Strøm²¹, Kevin C Wilson²², Jonathon D Truwit²³

Affiliations

¹ Division of Pulmonary, Critical Care & Occupational Medicine, University of Iowa, Iowa City, IA.
² Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
³ Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
⁴ Department of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY.
⁵ Department of Pulmonary Disease Service, Henry Ford Hospital, Detroit, MI.
⁶ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁷ Department of Nursing, University of Virginia Health System, Charlottesville, VA.
⁸ Division of Pulmonary, Critical Care and Sleep Medicine, Tufts University School of Medicine, Boston, MA.
⁹ Department of Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain.
¹⁰ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, CibeRes (CB06/06/0028), University of Barcelona, Barcelona, Spain.
¹² Maine Medical Center, Portland, ME.
¹³ Departments of Medicine and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
¹⁴ Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
¹⁵ Division of Respirology, University of Toronto, Toronto, ON, Canada.
¹⁶ Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI.
¹⁷ American College of Chest Physicians, Glenview, IL.
¹⁸ Department of Therapy Services, University of Chicago Medical Center, Chicago, IL.
¹⁹ Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
²⁰ Department of Internal Medicine, Division of Pulmonary and Critical Care, Virginia Commonwealth University School of Medicine, Richmond, VA.
²¹ Department of Anaesthesia and Intensive Care Medicine, University of Southern Denmark, Odense, Denmark.
²² Pulmonary, Allergy, Sleep and Critical Care Medicine, Boston University, Boston, MA.
²³ Divison of Pulmonary and Critical Care Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI. Electronic address: jtruwit@mcw.edu.

PMID: 27818329
DOI: 10.1016/j.chest.2016.10.037

Practice Guideline

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 et al. Chest. 2017 Jan.

. 2017 Jan;151(1):160-165.

doi: 10.1016/j.chest.2016.10.037. Epub 2016 Nov 3.

Authors

Affiliations

¹ Division of Pulmonary, Critical Care & Occupational Medicine, University of Iowa, Iowa City, IA.
² Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
³ Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
⁴ Department of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY.
⁵ Department of Pulmonary Disease Service, Henry Ford Hospital, Detroit, MI.
⁶ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁷ Department of Nursing, University of Virginia Health System, Charlottesville, VA.
⁸ Division of Pulmonary, Critical Care and Sleep Medicine, Tufts University School of Medicine, Boston, MA.
⁹ Department of Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain.
¹⁰ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, CibeRes (CB06/06/0028), University of Barcelona, Barcelona, Spain.
¹² Maine Medical Center, Portland, ME.
¹³ Departments of Medicine and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
¹⁴ Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
¹⁵ Division of Respirology, University of Toronto, Toronto, ON, Canada.
¹⁶ Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI.
¹⁷ American College of Chest Physicians, Glenview, IL.
¹⁸ Department of Therapy Services, University of Chicago Medical Center, Chicago, IL.
¹⁹ Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
²⁰ Department of Internal Medicine, Division of Pulmonary and Critical Care, Virginia Commonwealth University School of Medicine, Richmond, VA.
²¹ Department of Anaesthesia and Intensive Care Medicine, University of Southern Denmark, Odense, Denmark.
²² Pulmonary, Allergy, Sleep and Critical Care Medicine, Boston University, Boston, MA.
²³ Divison of Pulmonary and Critical Care Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI. Electronic address: jtruwit@mcw.edu.

PMID: 27818329
DOI: 10.1016/j.chest.2016.10.037

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.

Keywords: evidence-based medicine; guidelines; mechanical ventilation.

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Comment in

CHEST-ATS Guidelines on Weaning/Extubation Ignore Scientific Principles.
Tobin MJ. Tobin MJ. Chest. 2017 May;151(5):1179-1180. doi: 10.1016/j.chest.2017.01.039. Chest. 2017. PMID: 28483110 No abstract available.
Response.
Truwit JD, Girard TD, Kress JP, Ouellette DR, Schmidt GA. Truwit JD, et al. Chest. 2017 May;151(5):1180-1181. doi: 10.1016/j.chest.2017.02.027. Chest. 2017. PMID: 28483111 No abstract available.

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

Affiliations

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

Authors

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