TY - JOUR T1 - Set the Children Free: Making the Most of Ventilator Liberation Protocols JF - Respiratory Care SP - 1495 LP - 1497 DO - 10.4187/respcare.10584 VL - 67 IS - 11 AU - Kyle J Rehder AU - Travis Heath Y1 - 2022/11/01 UR - http://rc.rcjournal.com/content/67/11/1495.abstract N2 - Invasive mechanical ventilation is not a cure for any disease; it simply supports a patient while their underlying disease resolves. Each additional day of mechanical ventilation brings risk of complications including ventilator-induced lung injury and infection.1 Furthermore, length of ventilation is highly correlated with length of ICU stay and cost.2,3 Therefore, efforts to liberate patients from invasive mechanical ventilation as soon as is safely possible are in the best interest of the patient. Yet the decision of when to remove invasive mechanical ventilation can be challenging, as extubation failure is also associated with increased morbidity and mortality.4In this month’s issue of Respiratory Care, Loberger and colleagues5 present a single-center historical cohort study of a combined sedation and extubation readiness testing (ERT) protocol. Following the introduction of this protocol, length of ventilation was decreased by 23%, or 19.2 h, with no concomitant increase in extubation failure rates or unplanned extubations. Opioid doses were unchanged with protocol initiation, whereas benzodiazepine use was reduced.Their findings are consistent with a recent very large multi-center randomized clinical trial from the United Kingdom (the SANDWICH trial), which also demonstrated reduced duration of mechanical ventilation with a similar ventilator liberation protocol focused on frequent ERTs and titration of sedation.6 This larger study was less proscriptive about the choice of sedative medications and had a smaller effect size (median 6-h reduction compared to mean 20-h reduction in the Loberger et al study). Some … Correspondence: Kyle J Rehder MD CPPS. E-mail: kyle.rehder{at}duke.edu ER -