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

被引:212
|
作者
Ouellette, Daniel R. [1 ]
Patel, Sheena [2 ]
Girard, Timothy D. [3 ]
Morris, Peter E. [4 ]
Schmidt, Gregory A. [5 ]
Truwit, Jonathon D. [6 ,7 ]
Alhazzani, Waleed [8 ]
Burns, Suzanne M. [9 ]
Epstein, Scott K. [10 ]
Esteban, Andres [11 ]
Fan, Eddy [12 ]
Ferrer, Miguel [14 ]
Fraser, Gilles L. [15 ]
Gong, Michelle Ng [16 ,17 ]
Hough, Catherine L. [18 ]
Mehta, Sangeeta [13 ,19 ]
Nanchal, Rahul [7 ]
Pawlik, Amy J. [20 ]
Schweickert, William D. [21 ]
Sessler, Curtis N. [22 ]
Strom, Thomas [23 ]
Kress, John P. [24 ]
机构
[1] Henry Ford Hlth Syst, Detroit, MI USA
[2] CHEST, Glenview, IL USA
[3] Univ Pittsburgh, Pittsburgh, PA USA
[4] Univ Kentucky, Lexington, KY USA
[5] Univ Iowa, Div Pulm Crit Care & Occupat Med, Iowa City, IA USA
[6] Froedtert, Milwaukee, WI USA
[7] Med Coll Wisconsin, Milwaukee, WI 53226 USA
[8] McMaster Univ, Hamilton, ON, Canada
[9] Univ Virginia Hlth Syst, Charlottesville, VA USA
[10] Tufts Univ, Sch Med, Div Pulm Crit Care & Sleep Med, Boston, MA 02111 USA
[11] Univ Hosp Getafe, CIBER Enfermedades Resp, Unidad Cuidados Intens, Madrid, Spain
[12] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
[13] Univ Toronto, Div Respirol, Toronto, ON, Canada
[14] Univ Barcelona, Hosp Clin, Dept Pneumol, Resp Inst,IDIBAPS,CibeRes CB06 06 0028, Barcelona, Spain
[15] Maine Med Ctr, Portland, ME 04102 USA
[16] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Med, Bronx, NY 10467 USA
[17] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Epidemiol & Populat, Bronx, NY 10467 USA
[18] Univ Washington, Harborview Med Ctr, Div Pulm & Crit Care Med, 325 9Th Ave, Seattle, WA 98104 USA
[19] Mt Sinai Hosp, New York, NY 10029 USA
[20] Univ Chicago, Med Ctr, Dept Therapy Serv, Chicago, IL 60637 USA
[21] Univ Penn, Perelman Sch Med, Div Pulm Allergy & Crit Care, Philadelphia, PA 19104 USA
[22] Virginia Commonwealth Univ, Richmond, VA USA
[23] Univ Southern Denmark, Dept Anaesthesia & Intens Care Med, Odense, Denmark
[24] Univ Chicago, Sect Pulm & Crit Care, Chicago, IL 60637 USA
关键词
evidence-based medicine; guidelines; mechanical ventilation; INTENSIVE-CARE-UNIT; NONINVASIVE VENTILATION; PRESSURE SUPPORT; T-TUBE; INVASIVE VENTILATION; RESPIRATORY-FAILURE; SEDATIVE INFUSIONS; DAILY INTERRUPTION; BREATHING TRIALS; EXTUBATION;
D O I
10.1016/j.chest.2016.10.036
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND: An update of evidence-based guidelines concerning liberation from mechanical ventilation is needed as new evidence has become available. The American College of Chest Physicians (CHEST) and the American Thoracic Society (ATS) have collaborated to provide recommendations to clinicians concerning liberation from the ventilator. METHODS: Comprehensive evidence syntheses, including meta-analyses, were performed to summarize all available evidence relevant to the guideline panel's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, and the results were summarized in evidence profiles. The evidence syntheses were discussed and recommendations developed and approved by a multidisciplinary committee of experts in mechanical ventilation. RESULTS: Recommendations for three population, intervention, comparator, outcome (PICO) questions concerning ventilator liberation are presented in this document. The guideline panel considered the balance of desirable (benefits) and undesirable (burdens, adverse effects, costs) consequences, quality of evidence, feasibility, and acceptability of various interventions with respect to the selected questions. Conditional (weak) recommendations were made to use inspiratory pressure augmentation in the initial spontaneous breathing trial (SBT) and to use protocols to minimize sedation for patients ventilated for more than 24 h. A strong recommendation was made to use preventive noninvasive ventilation (NIV) for high-risk patients ventilated for more than 24 h immediately after extubation to improve selected outcomes. The recommendations were limited by the quality of the available evidence. CONCLUSIONS: The guideline panel provided recommendations for inspiratory pressure augmentation during an initial SBT, protocols minimizing sedation, and preventative NIV, in relation to ventilator liberation.
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收藏
页码:166 / 180
页数:15
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