title: Ventilator discontinuation protocols.
abstract: Mechanical ventilation is a life-saving supportive therapy, but it can also cause lung injury, diaphragmatic dysfunction, and lung infection. Ventilator liberation should be attempted as soon as clinically indicated, to minimize morbidity and mortality. The most effective method of  liberation follows a systematic approach that includes a daily assessment of weaning readiness, in conjunction with interruption of sedation infusions and spontaneous breathing trials. Protocols and checklists are decision support tools that help ensure consistent application of key elements  of evidence-based practice. A majority of studies of weaning protocols applied by non-physician healthcare providers suggest faster weaning and shorter duration of ventilation and ICU stay, and some suggest reduced failed extubation and ventilator-associated pneumonia rates. Checklists can  be used to reinforce application of the protocol, or possibly in lieu of one, particularly in environments where the caregiver-to-patient ratio is high and clinicians are well versed in and dedicated to applying evidence-based care. There is support for integrating best-evidence rules for  weaning into the mechanical ventilator so that a substantial portion of the weaning process can be automated, which may be most effective in environments with low caregiver-to-patient ratios or those in which it is challenging to consistently apply evidence-based care. This paper reviews evidence  for ventilator liberation protocols and discusses issues of implementation and ongoing monitoring.
authors.affiliation: Adult Respiratory Care Department, University of Michigan Health System, Ann Arbor, Michigan 48109-0024, USA. chaas@med.umich.edu
authors.forename: Carl F
authors.initials: CF
authors.lastname: Haas
authors.forename: Paul S
authors.initials: PS
authors.lastname: Loik
mesh_terms: D003661:Decision Support Techniques; D006801:Humans; D011237:Predictive Value of Tests; D012121:Respiration, Artificial / Q000009:adverse effects; D012129:Respiratory Function Tests; D015300:Ventilator Weaning / Q000145:classification / Q000379:methods*