AARC Clinical Practice Guideline: Patient-Ventilator Assessment

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Clinical Practice Guidelines

Background:

• Patient-ventilator assessments are crucial for safe and effective mechanical ventilation.
• Existing guidelines lack comprehensive, evidence-based recommendations for these assessments.
• The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was employed to address this gap.

Purpose of the Study:

• To develop evidence-based recommendations for essential patient-ventilator assessments.
• To guide respiratory therapists and clinicians in optimizing mechanical ventilation.
• To improve patient outcomes and reduce ventilator-associated complications.

Main Methods:

• A team of respiratory therapists and a librarian utilized the GRADE methodology.
• Systematic review and synthesis of evidence to formulate recommendations.
• Categorization of recommendations based on strength and certainty of evidence.

Main Results:

• Strong recommendations with high certainty for assessing plateau pressure, tidal volume (4-8 mL/kg/PBW), PEEP/auto-PEEP, and artificial airway cuff pressure.
• Conditional recommendations with varying certainty for assessing driving pressure, FiO2, humidification, and skin/dressing integrity.
• Recommendations also address telemonitoring versus direct bedside assessment and airway securement.

Conclusions:

• The developed recommendations provide a framework for standardized and effective patient-ventilator assessments.
• Implementing these guidelines can enhance lung-protective strategies and patient safety.
• Further research may be needed to strengthen recommendations with lower certainty levels.