Authors: Schmidt GA, Girard TD, Kress JP, Morris PE, Ouellette DR, Alhazzani W, Burns SM, Epstein SK, Esteban A, Fan E, Ferrer M, Fraser GL, Gong M, Hough C, Mehta S, Nanchal R, Patel S, Pawlik AJ, Sessler CN, Strøm T, Schweickert W, Wilson KC, Truwit JD.

Reference: Am J Respir Crit Care Med. 2016 Oct 20

Abstract
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 American College of Chest Physicians (CHEST).
METHODS:
A multi-disciplinary panel posed six clinical questions in a Population, Intervention, Comparator and Outcomes (PICO) 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 GRADE (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, confidence in the evidence, certainty about how much the public value 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.
CONCLUSION:
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.

Pubmed ID: 27762608