New Guidelines Published for Discontinuing Mechanical Ventil
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.

-For patients at high risk for extubation failure who have passed a spontaneous breathing trial (SBT), we recommend extubation to preventative non-invasive ventilation (NIV).

-We suggest that the initial SBT be conducted with inspiratory pressure augmentation rather than T-piece or CPAP

-We suggest protocols attempting to minimize sedation.

-We suggest protocolized rehabilitation directed toward early mobilization.

-We suggest managing patients with a ventilator liberation protocol.

-We suggest performing a cuff leak test in patients who meet extubation criteria and are deemed at high risk for post-extubation stridor.

-For patients who failed the cuff leak test but are otherwise ready for extubation, we suggest administering systemic steroids at least 4 hours before extubation...

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