Liberation From Mechanical Ventilation in Critically Ill Adults

The recommendations in these guidelines are the result of our expert panel’s interpretation of the existing evidence and how it may be applied in clinical practice. Only one recommendation, extubation to preventive noninvasive mechanical ventilation in high-risk patients, is strongly suggested. All others are considered conditional recommendations and include conducting SBTs with inspiratory pressure augmentation, using protocols to minimize sedation, using protocolized rehabilitation directed toward early mobilization, using ventilator liberation protocols, performing a CLT in mechanically ventilated patients who meet extubation criteria and are deemed at high risk for PES, and administering systemic steroids at least 4 h prior to extubation in patients who fail a CLT. A repeat CLT is not required.