AARC Clinical Practice Guideline: Patient-Ventilator Assessment

• Published in: Respiratory care Vol. 69; no. 8; p. 1042
• Main Authors: Goodfellow, Lynda T, Miller, Andrew G, Varekojis, Sarah M, LaVita, Carolyn J, Glogowski, Joel T, Hess, Dean R
• Format: Journal Article
• Language: English
• Published: United States 01.08.2024
• Subjects: Humans; Positive-Pressure Respiration - instrumentation; Positive-Pressure Respiration - methods; Respiration, Artificial - methods; Tidal Volume; Ventilator-Induced Lung Injury - prevention & control; Ventilators, Mechanical; Auscultation; Dyspnea; Stability; Mechanical Ventilation; Adjustments; Evidence-Based Respiratory Care; Patient distress; Safety; Trends; Patient assessment; Physical examination; Guidelines
• DOI: 10.4187/respcare.12007

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 (V ) to ensure lung-protective ventilation (4-8 mL/kg/predicted body weight) (strong recommendation, high certainty); (3) We recommend documenting V 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 F 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).