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Guideline
- Pulmonary
- Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines
- Tae Sun Ha, Dong Kyu Oh, Hak-Jae Lee, Youjin Chang, In Seok Jeong, Yun Su Sim, Suk-Kyung Hong, Sunghoon Park, Gee Young Suh, So Young Park
- Acute Crit Care. 2024;39(1):1-23. Published online February 28, 2024
- DOI: https://doi.org/10.4266/acc.2024.00052
- 36,147 View
- 1,861 Download
- 2 Web of Science
- 4 Crossref
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Abstract
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Supplementary Material - Background
Successful liberation from mechanical ventilation is one of the most crucial processes in critical care because it is the first step by which a respiratory failure patient begins to transition out of the intensive care unit and return to their own life. Therefore, when devising appropriate strategies for removing mechanical ventilation, it is essential to consider not only the individual experiences of healthcare professionals, but also scientific and systematic approaches. Recently, numerous studies have investigated methods and tools for identifying when mechanically ventilated patients are ready to breathe on their own. The Korean Society of Critical Care Medicine therefore provides these recommendations to clinicians about liberation from the ventilator.
Methods
Meta-analyses and comprehensive syntheses were used to thoroughly review, compile, and summarize the complete body of relevant evidence. All studies were meticulously assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method, and the outcomes were presented succinctly as evidence profiles. Those evidence syntheses were discussed by a multidisciplinary committee of experts in mechanical ventilation, who then developed and approved recommendations.
Results
Recommendations for nine PICO (population, intervention, comparator, and outcome) questions about ventilator liberation are presented in this document. This guideline includes seven conditional recommendations, one expert consensus recommendation, and one conditional deferred recommendation.
Conclusions
We developed these clinical guidelines for mechanical ventilation liberation to provide meaningful recommendations. These guidelines reflect the best treatment for patients seeking liberation from mechanical ventilation. -
Citations
Citations to this article as recorded by
- Comparison of programmed sedation care with conventional care in patients receiving mechanical ventilation for acute respiratory failure
Jiantang Wang, Yuntao Li, Yujuan Han, Xinyu Yuan
Irish Journal of Medical Science (1971 -).2025; 194(1): 289. CrossRef - Clinical predictors of extubation failure in postoperative critically ill patients: a post-hoc analysis of a multicenter prospective observational study
Jun Hattori, Aiko Tanaka, Junko Kosaka, Osamu Hirao, Nana Furushima, Yuichi Maki, Daijiro Kabata, Akinori Uchiyama, Moritoki Egi, Hiroshi Morimatsu, Satoshi Mizobuchi, Yoshifumi Kotake, Ayumi Shintani, Yukiko Koyama, Takeshi Yoshida, Yuji Fujino
BMC Anesthesiology.2025;[Epub] CrossRef - Comparison of High Versus Low Positive End-Expiratory Pressure in Mechanically Ventilated Patients With Acute Heart Failure: Rationale and Design of the HELP-AHF Trial
Junho Hyun, In-Cheol Kim, Ah-ram Kim, Hee Jeong Lee, Sang Eun Lee, Sung-Cheol Yun, Min-Seok Kim
International Journal of Heart Failure.2025; 7(2): 79. CrossRef - RELAÇÃO DA FORÇA MUSCULAR PERIFÉRICA COM O DESMAME DA VENTILAÇÃO MECÂNICA
Débora Rillary Duarte Filho, Gabriella Schultz Malagute, Luciana Ferreira Rihs, Priscila Corrêa Cavalcanti
Revista Saúde Dos Vales.2024;[Epub] CrossRef
- Comparison of programmed sedation care with conventional care in patients receiving mechanical ventilation for acute respiratory failure
Original Article
- Nursing
- The effects of environmental interventions for delirium in critically ill surgical patients
- Hak-Jae Lee, Yoon-Joong Jung, Nak-Joon Choi, Suk-Kyung Hong
- Acute Crit Care. 2023;38(4):479-487. Published online November 28, 2023
- DOI: https://doi.org/10.4266/acc.2023.00990
- 9,326 View
- 212 Download
- 6 Web of Science
- 6 Crossref
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Abstract
PDF
- Background
Delirium occurs at high rates among patients in intensive care units and increases the risk of morbidity and mortality. The purpose of this study was to investigate the effects of environmental interventions on delirium.
Methods
This prospective cohort study enrolled 192 patients admitted to the surgical intensive care unit (SICU) during the pre-intervention (June 2013 to October 2013) and post-intervention (June 2014 to October 2014) periods. Environmental interventions involved a cognitive assessment, an orientation, and a comfortable environment including proper sleep conditions. The primary outcomes were the prevalence, duration, and onset of delirium.
Results
There were no statistically significant differences in incidence rate, time of delirium onset, general characteristics, and mortality between the pre-intervention and post-intervention groups. The durations of delirium were 14.4±19.1 and 7.7±7.3 days in the pre-intervention and post-intervention groups, respectively, a significant reduction (P=0.027). The lengths of SICU stay were 20.0±22.9 and 12.6±8.7 days for the pre-intervention and post-intervention groups, respectively, also a significant reduction (P=0.030).
Conclusions
The implementation of an environmental intervention program reduced the duration of delirium and length of stay in the SICU for critically ill surgical patients. -
Citations
Citations to this article as recorded by- The effectiveness of family participation interventions for the prevention of delirium in intensive care units: A systematic review
Marli Lopo Vitorino, Adriana Henriques, Graça Melo, Helga Rafael Henriques
Intensive and Critical Care Nursing.2025; 89: 103976. CrossRef - Delirium in Critically Ill Geriatric Surgical Patients: A Systematic Review of Screening, Risk Factors, Diagnosis, and Management
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Journal of Orthopaedic Surgery and Research.2025;[Epub] CrossRef - The effects of restricted visitation on delirium incidence in the intensive care units of a tertiary hospital in South Korea
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Aging Clinical and Experimental Research.2024;[Epub] CrossRef
- The effectiveness of family participation interventions for the prevention of delirium in intensive care units: A systematic review
Corrigendum
- Pharmacology
- 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit
- Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha
- Acute Crit Care. 2023;38(1):149-149. Published online February 27, 2023
- DOI: https://doi.org/10.4266/acc.2022.00094.e1
- Corrects: Acute Crit Care 2022;37(1):1
- 5,980 View
- 352 Download
- 2 Web of Science
- 3 Crossref
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PDF
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Citations
Citations to this article as recorded by- Barriers and Facilitators to the Implementation of Analgesia and Sedation Management Strategies Among ICU Healthcare Professionals: A Mixed Methods Systematic Review
Huiqin Shi, Jingying Huang, Kailai Gu, Jin Yang, Mengbo Han
Nursing in Critical Care.2026;[Epub] CrossRef - Association between delirium severity and prognosis following Transcatheter aortic valve implantation
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Journal of Cardiology.2025; 86(1): 38. CrossRef - Can we make a safer sedation?
M.S. Danilov, I.S. Simutis, A.S. Korotaev, D.S. Salygina, V.A. Ratnikov, V.A. Kashchenko
Russian Journal of Anesthesiology and Reanimatology.2023; (4): 49. CrossRef
- Barriers and Facilitators to the Implementation of Analgesia and Sedation Management Strategies Among ICU Healthcare Professionals: A Mixed Methods Systematic Review
Guideline
- Pharmacology
- 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit
- Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha
- Acute Crit Care. 2022;37(1):1-25. Published online February 28, 2022
- DOI: https://doi.org/10.4266/acc.2022.00094
- Correction in: Acute Crit Care 2023;38(1):149
- 65,535 View
- 3,276 Download
- 50 Web of Science
- 71 Crossref
-
Abstract
PDF
- We revised and expanded the “2010 Guideline for the Use of Sedatives and Analgesics in the Adult Intensive Care Unit (ICU).” We revised the 2010 Guideline based mainly on the 2018 “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult Patients in the ICU,” which was an updated 2013 pain, agitation, and delirium guideline with the inclusion of two additional topics (rehabilitation/mobility and sleep). Since it was not possible to hold face-to-face meetings of panels due to the coronavirus disease 2019 (COVID-19) pandemic, all discussions took place via virtual conference platforms and e-mail with the participation of all panelists. All authors drafted the recommendations, and all panelists discussed and revised the recommendations several times. The quality of evidence for each recommendation was classified as high (level A), moderate (level B), or low/very low (level C), and all panelists voted on the quality level of each recommendation. The participating panelists had no conflicts of interest on related topics. The development of this guideline was independent of any industry funding. The Pain, Agitation/Sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep Disturbance panels issued 42 recommendations (level A, 6; level B, 18; and level C, 18). The 2021 clinical practice guideline provides up-to-date information on how to prevent and manage pain, agitation/sedation, delirium, immobility, and sleep disturbance in adult ICU patients. We believe that these guidelines can provide an integrated method for clinicians to manage PADIS in adult ICU patients.
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Citations
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