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Practice Guideline
. 2024 Jul 24;69(8):1042-1054.
doi: 10.4187/respcare.12007.

AARC Clinical Practice Guideline: Patient-Ventilator Assessment

Lynda T Goodfellow  1 , Andrew G Miller  2 , Sarah M Varekojis  3 , Carolyn J LaVita  4 , Joel T Glogowski  5 , Dean R Hess  6
Affiliations
Practice Guideline

AARC Clinical Practice Guideline: Patient-Ventilator Assessment

Lynda T Goodfellow et al. Respir Care. .

Abstract

Given the important role of patient-ventilator assessments in ensuring the safety and efficacy of mechanical ventilation, a team of respiratory therapists and a librarian used Grading of Recommendations, Assessment, Development, and Evaluation methodology to make the following recommendations: (1) We recommend assessment of plateau pressure to ensure lung-protective ventilator settings (strong recommendation, high certainty); (2) We recommend an assessment of tidal volume (VT) to ensure lung-protective ventilation (4-8 mL/kg/predicted body weight) (strong recommendation, high certainty); (3) We recommend documenting VT as mL/kg predicted body weight (strong recommendation, high certainty); (4) We recommend an assessment of PEEP and auto-PEEP (strong recommendation, high certainty); (5) We suggest assessing driving pressure to prevent ventilator-induced injury (conditional recommendation, low certainty); (6) We suggest assessing FIO2 to ensure normoxemia (conditional recommendation, very low certainty); (7) We suggest telemonitoring to supplement direct bedside assessment in settings with limited resources (conditional recommendation, low certainty); (8) We suggest direct bedside assessment rather than telemonitoring when resources are adequate (conditional recommendation, low certainty); (9) We suggest assessing adequate humidification for patients receiving noninvasive ventilation (NIV) and invasive mechanical ventilation (conditional recommendation, very low certainty); (10) We suggest assessing the appropriateness of the humidification device during NIV and invasive mechanical ventilation (conditional recommendation, low certainty); (11) We recommend that the skin surrounding artificial airways and NIV interfaces be assessed (strong recommendation, high certainty); (12) We suggest assessing the dressing used for tracheostomy tubes and NIV interfaces (conditional recommendation, low certainty); (13) We recommend assessing the pressure inside the cuff of artificial airways using a manometer (strong recommendation, high certainty); (14) We recommend that continuous cuff pressure assessment should not be implemented to decrease the risk of ventilator-associated pneumonia (strong recommendation, high certainty); and (15) We suggest assessing the proper placement and securement of artificial airways (conditional recommendation, very low certainty).

Keywords: Adjustments; Auscultation; Dyspnea; Evidence-Based Respiratory Care; Guidelines; Mechanical Ventilation; Patient assessment; Patient distress; Physical examination; Safety; Stability; Trends.

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Conflict of interest statement

Mr Miller discloses relationships with the Board of Directors for the Carolina/Virginias Chapter of Society of Critical Care Medicine, Saxe Communication, Fisher & Paykel, S2N Health, MedEx Research, and Aerogen. Mr Miller is a section editor for Respiratory Care. Dr Varekojis discloses relationships with The Ohio State University, the Commission on Accreditation for Respiratory Care, and American Association for Respiratory Care/Daedalus Enterprises. Dr LaVita discloses relationships with Orange Medical-Nihon Kohden, Timpel, and VERO Bio Tech. Mr Glogowski discloses a relationship with Georgia State University. Dr Goodfellow discloses relationships with the American Association for Respiratory Care/Daedalus Enterprises and Georgia State University. Dr Hess discloses a relationship with the American Association for Respiratory Care/Daedalus Enterprises, Massachusetts General Hospital, Northeastern University, Lungpacer, Jones & Bartlett, McGraw Hill, UpToDate, and the University of Pittsburgh. Dr Hess is managing editor for Respiratory Care.

Figures

Fig. 1.
Fig. 1.
Essential components of a patient-ventilator assessment.
See this image and copyright information in PMC

References

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