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Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure

Bram Rochwerg, Laurent Brochard, Mark W. Elliott, Dean Hess, Nicholas S. Hill, Stefano Nava, Paolo Navalesi (members of the steering committee), Massimo Antonelli, Jan Brozek, Giorgio Conti, Miquel Ferrer, Kalpalatha Guntupalli, Samir Jaber, Sean Keenan, Jordi Mancebo, Sangeeta Mehta, Suhail Raoof (members of the task force)
European Respiratory Journal 2017 50: 1602426; DOI: 10.1183/13993003.02426-2016
Bram Rochwerg
1Dept of Medicine, Dept of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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  • ORCID record for Bram Rochwerg
Laurent Brochard
2Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
3Keenan Research Centre and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
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Mark W. Elliott
4Dept of Respiratory Medicine, St James's University Hospital, Leeds, UK
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Dean Hess
5Respiratory Care Dept, Massachusetts General Hospital and Dept of Anesthesia, Harvard Medical School, Boston, MA, USA
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Nicholas S. Hill
6Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA
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Stefano Nava
7Dept of Specialistic, Diagnostic and Experimental Medicine, Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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  • For correspondence: Stefanava@gmail.com
Paolo Navalesi (members of the steering committee)
8Anesthesia and Intensive Care, Dept of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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Massimo Antonelli
9Dept of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy
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Jan Brozek
1Dept of Medicine, Dept of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Giorgio Conti
9Dept of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy
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Miquel Ferrer
10Dept of Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and CIBERES, Barcelona, Spain
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Kalpalatha Guntupalli
11Depts of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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Samir Jaber
12Dept of Critical Care Medicine and Anesthesiology (DAR B), Research Unit INSERM U1046, Saint Eloi University Hospital and Montpellier School of Medicine, Montpellier, France
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Sean Keenan
13Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
14Dept of Critical Care Medicine, Royal Columbian Hospital, New Westminster, BC, Canada
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Jordi Mancebo
15Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
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Sangeeta Mehta
16Mount Sinai Hospital and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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Suhail Raoof (members of the task force)
17Pulmonary and Critical Care Medicine, Lenox Hill Hospital, New York, NY, USA
18Hofstra Northwell School of Medicine, Hempstead, NY, USA
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  • Article
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Tables

  • Supplementary Materials
  • TABLE 1

    Interpretation of strong and conditional recommendations for stakeholders (patients, clinicians and healthcare policy makers)

    Strong recommendationWeak recommendation
    For patientsMost individuals in this situation would want the recommended course of action and only a small proportion would not.The majority of individuals in this situation would want the suggested course of action, but many would not.
    For cliniciansMost individuals should receive the recommended course of action. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.Different choices are likely to be appropriate for different patients and therapy should be tailored to the individual patient's circumstances. Those circumstances may include the patient or family's values and preferences.
    For policy makersThe recommendation can be adapted as policy in most situations including for the use as performance indicators.Policy making will require substantial debates and involvement of many stakeholders. Policies are also more likely to vary between regions. Performance indicators would have to focus on the fact that adequate deliberation about the management options has taken place.
  • TABLE 2

    Recommendations for actionable PICO questions

    Clinical indication#Certainty of evidence¶Recommendation
    Prevention of hypercapnia in COPD exacerbation⊕⊕Conditional recommendation against
    Hypercapnia with COPD exacerbation⊕⊕⊕⊕Strong recommendation for
    Cardiogenic pulmonary oedema⊕⊕⊕Strong recommendation for
    Acute asthma exacerbationNo recommendation made
    Immunocompromised⊕⊕⊕Conditional recommendation for
    De novo respiratory failureNo recommendation made
    Post-operative patients⊕⊕⊕Conditional recommendation for
    Palliative care⊕⊕⊕Conditional recommendation for
    Trauma⊕⊕⊕Conditional recommendation for
    Pandemic viral illnessNo recommendation made
    Post-extubation in high-risk patients (prophylaxis)⊕⊕Conditional recommendation for
    Post-extubation respiratory failure⊕⊕Conditional recommendation against
    Weaning in hypercapnic patients⊕⊕⊕Conditional recommendation for

    #: all in the setting of acute respiratory failure; ¶: certainty of effect estimates: ⊕⊕⊕⊕, high; ⊕⊕⊕, moderate; ⊕⊕, low; ⊕, very low.

    Supplementary Materials

    • Tables
    • Supplementary Material

      Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

      Technical summary: Practical application of noninvasive ventilation in the hospital setting ERJ-02426-2016_Technical_summary

      Supplementary material: extended methods section ERJ-02426-2016_Extended_methods

      Supplementary material: evidence profiles and forest plots ERJ-02426-2016_Evidence_profiles

    • Supplementary Material

      M. Antonelli ERJ-02426-2016_Antonelli

      L. Brochard ERJ-02426-2016_Brochard

      M.W. Elliott ERJ-02426-2016_Elliott

      K. Guntupalli ERJ-02426-2016_Guntupalli

      D. Hess ERJ-02426-2016_Hess

      N. Hill ERJ-02426-2016_Hill

      S. Jaber ERJ-02426-2016_Jaber

      J. Mancebo ERJ-02426-2016_Mancebo

      S. Nava ERJ-02426-2016_Nava

      P. Navalesi ERJ-02426-2016_Navalesi

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    Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure
    Bram Rochwerg, Laurent Brochard, Mark W. Elliott, Dean Hess, Nicholas S. Hill, Stefano Nava, Paolo Navalesi, Massimo Antonelli, Jan Brozek, Giorgio Conti, Miquel Ferrer, Kalpalatha Guntupalli, Samir Jaber, Sean Keenan, Jordi Mancebo, Sangeeta Mehta, Suhail Raoof
    European Respiratory Journal Aug 2017, 50 (2) 1602426; DOI: 10.1183/13993003.02426-2016

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    Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure
    Bram Rochwerg, Laurent Brochard, Mark W. Elliott, Dean Hess, Nicholas S. Hill, Stefano Nava, Paolo Navalesi, Massimo Antonelli, Jan Brozek, Giorgio Conti, Miquel Ferrer, Kalpalatha Guntupalli, Samir Jaber, Sean Keenan, Jordi Mancebo, Sangeeta Mehta, Suhail Raoof
    European Respiratory Journal Aug 2017, 50 (2) 1602426; DOI: 10.1183/13993003.02426-2016
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