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

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.

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

“…This guideline is the companion to another guideline that is being published separately and addresses questions related to physical rehabilitation protocols, ventilator liberation protocols, and the cuff leak test. 1 Neither guideline is intended to impose a standard of care. They provide the basis for rational decisions in the liberation of patients from mechanical ventilation.…”

Precision Medicine in Critical Illness: Sepsis and Acute Respiratory Distress Syndrome

“…One major factor that may contribute to this treatment gap is the profound heterogeneity encompassed by patients meeting criteria for each syndrome. A valid concern is that our syndromic definitions [9][10][11], although useful in identifying patients who share clinical factors and who may benefit from standardized care [12][13][14][15], may have almost no utility in predicting a patient's biologic subclassification nor in predicting mortality, expected complications, or response to therapy. Precision medicine options for these syndromes, whereby the correct drug could be targeted to the patients most likely to be helped and least likely to be harmed, are sorely needed.…”

The Strong Cough: Is It a Signpost on the Road to Extubation or Just a Dead End?

“…6,7,9 Brain natriuretic peptide levels and measurements of SEE THE ORIGINAL STUDY ON PAGE 1505 diastolic function by transthoracic echocardiography have been proposed to measure cardiac function, and a cuff-leak test for upper airway obstruction has been advocated in the most recent American Thoracic Society/American College of Chest Physicians practice guideline for assessing ventilator liberation readiness. 7,10 These tests, by themselves, are moderately able to predict the success of a patient population, but they are less successful in predicting an individual's success, as evidenced by the relatively unchanged re-intubation rate. This suggests that there may be other conditions that need to be considered.…”