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) associated with better outcomes among adult patients with acute respiratory failure (ARF) or acute respiratory distress syndrome (ARDS) on the continuum of care, from intubation to liberation.
What EPBs are recommended to reduce the duration of IMV and mortality among patients with ARF/ARDS?
and Methods: We identified an initial set of reports linking EBPs to mortality and/or duration of IMV. We conducted a review of reviews, focusing on pre-appraised 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.
Our initial search produced 61 publications containing 42 EBPs. We excluded 42 manuscripts during the data extraction process, primarily because they were not associated with improved patient outcomes. The remaining 19 pre-appraised 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, 6 focus on intubation and escalation of care, such as ventilator management and synchrony; 10 reduce complications associated with IMV, including spontaneous awakening and breathing trials, and early mobility protocols; 4 promote timely extubation and post-extubation recovery.
This review describes EBPs associated with fewer ventilator days and/or lower mortality among patients receiving IMV for ARF/ARDS. Many of these EBPs are connected across the care continuum, indicating the need to promote and assess effective implementation jointly, rather than individually.
Copyright © 2020. Published by Elsevier Inc.