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DETROIT – In one of the most common dilemmas facing the ICU, reducing the length of time patients are on mechanical ventilation decreases the risk of complications, but premature removal can produce different problems, including increased mortality.
That’s why the American College of Chest Physicians (CHEST) and the American Thoracic Society (ATS) have published new guidelines for discontinuing mechanical ventilation in critically ill adults.
Their goal is to help clinicians determine when patients with acute respiratory failure can breathe on their own and to provide clinical advice that might increase the chances for successful extubation. Background information provided by the groups notes that about 40% of all patients in the ICU are breathing with the help of a mechanical ventilator at any given time.
While that can be a live-saver, the downside is that mechanical ventilation can lead to complications, including infections and injury to the lungs and other organs, according to the report.
"Our guidelines committee wished to update the 2001 CHEST guideline concerning ventilator liberation, but we wished to do so by addressing new clinical questions. Our goal was to translate the latest findings into guidelines to improve patient care," explained co-lead author Daniel R. Ouellette, MD, FCCP, an associate professor of medicine at Henry Ford Hospital in Detroit. "These latest guidelines are informed by many studies published in the last 10 to 15 years that look at other factors that critical care clinicians control that affect a patient's ability to be liberated from the ventilator in a timely manner."
Here is a summary of the recommendations, based on a systematic review of medical studies, for acutely hospitalized adults on mechanical ventilation for more than 24 hours:
"Our goal was not to prescribe approaches to care that should be applying without thought to every patient in every situation," added co-lead author Timothy Girard, MD, MSCI, associate professor of critical care medicine at the University of Pittsburgh. "Rather, we sought to summarize the best available evidence in a clear, succinct way so that clinicians know what the evidence says about how to liberate the majority of mechanically ventilated ICU patients quickly and safely."
Girard said that, with nearly every question the committee examined, “we found new evidence to guide clinical practice as well as a need for additional research."