TY - JOUR
T1 - Evidence-Based Practices for Acute Respiratory Failure and Acute Respiratory Distress Syndrome
T2 - A Systematic Review of Reviews
AU - Ervin, Jennifer N.
AU - Rentes, Victor C.
AU - Dibble, Emily R.
AU - Sjoding, Michael W.
AU - Iwashyna, Theodore J.
AU - Hough, Catherine L.
AU - Ng Gong, Michelle
AU - Sales, Anne E.
N1 - Publisher Copyright:
© 2020 The Authors
PY - 2020/12
Y1 - 2020/12
N2 - Background: The recent pandemic highlights the essential nature of optimizing the use of invasive mechanical ventilation (IMV) in complex critical care settings. This review of reviews maps evidence-based practices (EBPs) that are associated with better outcomes among adult patients with acute respiratory failure or ARDS on the continuum of care, from intubation to liberation. Research Question: What EPBs are recommended to reduce the duration of IMV and mortality rate among patients with acute respiratory failure/ARDS? Study Design and Methods: We identified an initial set of reports that links EBPs to mortality rates and/or duration of IMV. We conducted a review of reviews, focusing on preappraised guidelines, meta-analyses, and systematic reviews. We searched Scopus, CINAHL, and PubMed from January 2016 to January 2019 for additional evidence that has not yet been incorporated into current guidelines. Results: Our initial search produced 61 publications that contained 42 EBPs. We excluded 42 manuscripts during the data extraction process, primarily because they were not associated with improved patient outcomes. The remaining 19 preappraised guidelines, meta-analyses, and systematic reviews met our full inclusion criteria and spanned the continuum of IMV care from intubation to liberation. These contained 20 EBPs, a majority of which were supported with moderate levels of evidence. Of these, six EBPs focused on intubation and escalation of care, such as ventilator management and synchrony; ten EBPs reduced complications associated with IMV, which included spontaneous awakening and breathing trials and early mobility protocols; and four EBPs promoted timely extubation and postextubation recovery. Interpretation: This review describes EBPs that are associated with fewer ventilator days and/or lower mortality rates among patients who received IMV for acute respiratory failure/ARDS. Many of these EBPs are connected across the care continuum, which indicates the need to promote and assess effective implementation jointly, rather than individually.
AB - Background: The recent pandemic highlights the essential nature of optimizing the use of invasive mechanical ventilation (IMV) in complex critical care settings. This review of reviews maps evidence-based practices (EBPs) that are associated with better outcomes among adult patients with acute respiratory failure or ARDS on the continuum of care, from intubation to liberation. Research Question: What EPBs are recommended to reduce the duration of IMV and mortality rate among patients with acute respiratory failure/ARDS? Study Design and Methods: We identified an initial set of reports that links EBPs to mortality rates and/or duration of IMV. We conducted a review of reviews, focusing on preappraised guidelines, meta-analyses, and systematic reviews. We searched Scopus, CINAHL, and PubMed from January 2016 to January 2019 for additional evidence that has not yet been incorporated into current guidelines. Results: Our initial search produced 61 publications that contained 42 EBPs. We excluded 42 manuscripts during the data extraction process, primarily because they were not associated with improved patient outcomes. The remaining 19 preappraised guidelines, meta-analyses, and systematic reviews met our full inclusion criteria and spanned the continuum of IMV care from intubation to liberation. These contained 20 EBPs, a majority of which were supported with moderate levels of evidence. Of these, six EBPs focused on intubation and escalation of care, such as ventilator management and synchrony; ten EBPs reduced complications associated with IMV, which included spontaneous awakening and breathing trials and early mobility protocols; and four EBPs promoted timely extubation and postextubation recovery. Interpretation: This review describes EBPs that are associated with fewer ventilator days and/or lower mortality rates among patients who received IMV for acute respiratory failure/ARDS. Many of these EBPs are connected across the care continuum, which indicates the need to promote and assess effective implementation jointly, rather than individually.
KW - ARDS
KW - acute respiratory failure
KW - evidence-based practice
KW - invasive mechanical ventilation
UR - http://www.scopus.com/inward/record.url?scp=85096644481&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85096644481&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2020.06.080
DO - 10.1016/j.chest.2020.06.080
M3 - Article
C2 - 32682771
AN - SCOPUS:85096644481
SN - 0012-3692
VL - 158
SP - 2381
EP - 2393
JO - CHEST
JF - CHEST
IS - 6
ER -