Liberation From Mechanical Ventilation in Critically Ill Adults: Executive Summary of an Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline.
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.
Division of Pulmonary, Critical Care & Occupational Medicine, University of Iowa, Iowa City, IA.
Gregory A
GA
Schmidt
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Timothy D
TD
Girard
Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
John P
JP
Kress
Department of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY.
Peter E
PE
Morris
Department of Pulmonary Disease Service, Henry Ford Hospital, Detroit, MI.
Daniel R
DR
Ouellette
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Waleed
W
Alhazzani
Department of Nursing, University of Virginia Health System, Charlottesville, VA.
Suzanne M
SM
Burns
Division of Pulmonary, Critical Care and Sleep Medicine, Tufts University School of Medicine, Boston, MA.
Scott K
SK
Epstein
Department of Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain.
Andres
A
Esteban
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Eddy
E
Fan
Department of Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, CibeRes (CB06/06/0028), University of Barcelona, Barcelona, Spain.
Miguel
M
Ferrer
Maine Medical Center, Portland, ME.
Gilles L
GL
Fraser
Departments of Medicine and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Michelle Ng
MN
Gong
Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
Catherine L
CL
Hough
Division of Respirology, University of Toronto, Toronto, ON, Canada.
Sangeeta
S
Mehta
Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI.
Rahul
R
Nanchal
American College of Chest Physicians, Glenview, IL.
Sheena
S
Patel
Department of Therapy Services, University of Chicago Medical Center, Chicago, IL.
Amy J
AJ
Pawlik
Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
William D
WD
Schweickert
Department of Internal Medicine, Division of Pulmonary and Critical Care, Virginia Commonwealth University School of Medicine, Richmond, VA.
Curtis N
CN
Sessler
Department of Anaesthesia and Intensive Care Medicine, University of Southern Denmark, Odense, Denmark.
Thomas
T
Strøm
Pulmonary, Allergy, Sleep and Critical Care Medicine, Boston University, Boston, MA.
Kevin C
KC
Wilson
Divison of Pulmonary and Critical Care Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI. Electronic address: jtruwit@mcw.edu.
Jonathon D
JD
Truwit
D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making; D003422:Critical Care / Q000379:methods / Q000592:standards; D016638:Critical Illness / Q000628:therapy*; D055416:Evidence-Based Emergency Medicine / Q000379:methods; D006801:Humans; D012121:Respiration, Artificial / Q000379:methods*; D014481:United States
evidence-based medicine; guidelines; mechanical ventilation