Recommendations
➤ For acutely hospitalized adults who have been mechanically ventilated
for >24 hours, the ATS and CHEST suggest protocolized rehabilitation
directed toward early mobilization.
(Conditional recommendation, low certainty in the evidence)
• Remark: There is insufficient evidence to recommend any rehabilitation protocol over
another.
➤ The ATS and CHEST suggest managing acutely hospitalized adults
who have been mechanically ventilated for >24 hours with a ventilator
liberation protocol.
(Conditional recommendation, low certainty in the evidence)
• Remark: The ventilator liberation protocol may be either personnel-driven or
computer-driven.
➤ The ATS and CHEST suggest performing a cuff leak test (CLT) in
mechanically ventilated adults who meet extubation criteria and are
deemed high risk for post-extubation stridor (PES).
(Conditional recommendation, very low certainty in the evidence)
• Remark: Risk factors for PES include: traumatic intubation, intubation >6 days, large
endotracheal tube, female sex, and reintubation after unplanned extubation.
➤ For adults who have failed a CLT but are otherwise ready for extubation,
the ATS and CHEST suggest administering systemic steroids 4 –24 hours
before extubation.
(Conditional recommendation, moderate certainty in the evidence)
• Remark: A repeat CLT is not required following the administration of systemic
steroids.
