CHEST-ATS Guidelines on Weaning/Extubation Ignore Scientific Principles

The new American College of Chest Physicians/American Thoracic Society guidelines on ventilator weaning/extubation1,2,3 fail to take into account well-proven principles of diagnostic testing and basic pulmonary physiology. I invite the committee's response to four points.

• 1.The committee states "weaning predictors…lack sufficient positive and negative predictive value to make them routinely useful." The assertion is unreferenced. The previous guidelines reached the same conclusion based on a meta-analysis that contained 15 major methodological errors.4 No error has been defended. Members of the previous committee were contacted repeatedly by the Editor in Chief of Critical Care Medicine but refused to respond.5 The committee chair merely repeated assertions.5 On what data does the committee base its assertion?

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