Chest
Evidence-Based MedicineLiberation From Mechanical Ventilation in Critically Ill Adults: Executive Summary of an Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline
Section snippets
Methods
Six cochairs were appointed, three each by the ATS and CHEST leadership, and reviewed for credentials and possible conflicts of interest. The six cochairs (T. D. G., P. E. M., J. D.T. from ATS and J. P. K., D. R. O., and G. A. S. from CHEST) suggested panelists to the ATS and CHEST staff, who then invited and reviewed them for potential conflicts of interest and finally approved them. The final panel consisted of the six cochairs, eight pulmonary/critical care physicians, four critical care
Results
ATS and CHEST elected to share publication of the guideline, which consists of six questions and the related evidence syntheses and recommendations (Table 2). After appropriate review by the ATS and CHEST leadership, the guidelines are published as three manuscripts: an executive summary and two manuscripts that address three questions each. The panel made recommendations but did not support specific protocols for any of the six questions. One of two manuscripts is published in CHEST3 and the
Summary
The recommendations in these guidelines are the result of our expert panel’s interpretation of the existing evidence and how it may be applied in clinical practice. Only one recommendation, extubation to preventive noninvasive mechanical ventilation in high-risk patients, is strongly suggested. All others are considered conditional recommendations and include conducting SBTs with inspiratory pressure augmentation, using protocols to minimize sedation, using protocolized rehabilitation directed
Acknowledgments
Author contributions: All authors participated in confirmation of literature review, evidence to decision process, authorship and editing of document. The six cochairs (T. D. G., P. E. M., J. D. T., J. P. K., D. R. O., G. A. S.) proposed the PICO questions. W. A. and S. P. were also methodologists. J. D. T. is the guarantor of the paper.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: K. C. W. reports being employed by the ATS as the Chief of Documents and
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Liberation from mechanical ventilation in critically ill adults: an official American College of Chest Physicians/American Thoracic Society clinical practice guideline
Chest
(2017) - et al.
GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction
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Cited by (0)
DISCLAIMER: American College of Chest Physician guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://www.chestnet.org/Guidelines-and-Resources/Guidelines-and-Consensus-Statements/CHEST-Guidelines.
This Executive Summary is an overview of the official ATS/CHEST clinical practice guideline. It is being simultaneously published in Chest and the American Journal of Respiratory and Critical Care Medicine.
FUNDING/SUPPORT: This study was funded in total by internal funds from the American College of Chest Physicians.