Official Executive Summary of an American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically III Adults
Official Executive Summary of an American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically III Adults
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DOI：
10.1164/rccm.201610-2076st
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发表时间：
2017-01-01
影响因子：
24.7
通讯作者：
Truwit, Jonathon D.
中科院分区：
文献类型：
--
作者：
Schmidt, Gregory A.;Girard, Timothy D.;Truwit, Jonathon D.
背景：本临床实践指南解决了与危重成人摆脱机械通气相关的六个问题。它是美国胸科学会和美国胸科医师学会之间合作的结果。方法：多学科小组以人群、干预、比较和结果的形式提出了六个临床问题。对每个问题进行了全面的文献检索和证据合成，其中包括使用建议分级、评估、制定和评估方法评估证据的确定性（即证据的质量）。将证据到决策框架应用于每个问题，要求专家组评估和权衡问题的重要性、证据的可信度、公众对主要结果的重视程度的确定性、期望和不良结果的程度和平衡、与干预相关的资源和成本、对健康差异的影响以及干预的可接受性和可行性。 结果：基于证据的建议最初由小组委员会制定和分级，然后在全小组委员会后修改讨论。这些建议通过保密电子投票得到确认；批准要求至少 80% 的小组成员同意该建议。结论：小组提供了有关摆脱机械通气的建议。有关每项建议的证据和理由的详细信息，请参见《美国呼吸与重症监护医学杂志》和《胸部杂志》。
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 and the American College of Chest Physicians.Methods: A multidisciplinary panel posed six clinical questions in a Population, Intervention, Comparator, and Outcomes format. A comprehensive literature search and evidence synthesis was performed for each question, which included appraising the certainty in the evidence (i.e., the quality of evidence) using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The Evidence-to-Decision framework was applied to each question, requiring the panel to evaluate and weigh the importance of the problem, the confidence in the evidence, the certainty about how much the public values the main outcomes, the magnitude and balance of desirable and undesirable outcomes, the resources and costs associated with the intervention, the impact on health disparities, and the acceptability and feasibility of the intervention.Results: Evidence-based recommendations were formulated and graded initially by subcommittees and then modified after 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.