title: 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.
abstract: 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.
  
  
  
  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 certainty in the evidence, and the feasibility and acceptability of various interventions. Recommendations were rated as strong or conditional.
  
  
  
  The guideline panel made four conditional recommendations 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.
  
  
  
  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.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Girard
authors.forename: Waleed
authors.initials: W
authors.lastname: Alhazzani
authors.forename: John P
authors.initials: JP
authors.lastname: Kress
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Ouellette
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Schmidt
authors.forename: Jonathon D
authors.initials: JD
authors.lastname: Truwit
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Burns
authors.forename: Scott K
authors.initials: SK
authors.lastname: Epstein
authors.forename: Andres
authors.initials: A
authors.lastname: Esteban
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.forename: Miguel
authors.initials: M
authors.lastname: Ferrer
authors.forename: Gilles L
authors.initials: GL
authors.lastname: Fraser
authors.forename: Michelle Ng
authors.initials: MN
authors.lastname: Gong
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Hough
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.forename: Rahul
authors.initials: R
authors.lastname: Nanchal
authors.forename: Sheena
authors.initials: S
authors.lastname: Patel
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Pawlik
authors.forename: William D
authors.initials: WD
authors.lastname: Schweickert
authors.forename: Curtis N
authors.initials: CN
authors.lastname: Sessler
authors.forename: Thomas
authors.initials: T
authors.lastname: Strøm
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Wilson
authors.forename: Peter E
authors.initials: PE
authors.lastname: Morris
mesh_terms: D000328:Adult; D002985:Clinical Protocols / Q000592:standards; D016638:Critical Illness / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal / Q000592:standards; D012121:Respiration, Artificial / Q000592:standards*; D015300:Ventilator Weaning / Q000592:standards*