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This Concise Critical Appraisal discusses the major changes to the ventilator liberation guidelines, including completing spontaneous breathing trials before noon but not requiring low-level pressure support ventilation, not increasing fraction of inspired oxygen, and no longer needing a rapid shallow breathing index.
Before liberating a patient from mechanical ventilation, a weaning process is used to determine whether the artificial airway can safely be removed. Weaning methods include intermittent mandatory ventilation, synchronized intermittent ventilation, and pressure support ventilation. A spontaneous breathing trial (SBT) is a period of spontaneous breathing typically lasting 30 to 120 minutes with little to no positive pressure ventilatory assistance. Studies have found that clinicians are slow to recognize readiness for extubation in nearly 75% of patients.1 One study reported that only 55% of patients who pass an SBT are liberated from the ventilator before an additional SBT is performed.2 Therefore, current guidelines have been fine-tuned to allow for earlier extubation without increasing the risk of complications. In 2017, the American Thoracic Society published guidelines on performing SBTs using post-extubation noninvasive ventilation, sedation management during SBT, and a cuff leak test.3 In this Concise Critical Appraisal, we highlight the key takeaways from the latest American Association for Respiratory Care mechanical ventilation liberation guidelines.4 Similarities to the 2017 Ventilator Weaning/Discontinuation Guidelines3:
Posted: 6/13/2024 | 0 comments
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