Consensus Statements

Mechanical Ventilation: Beyond the ICU
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Ventilator-assisted individual (VAI) is used in this consensus statement as a preferred term to describe a person who is chronically dependent on mechanical ventilation, ie, a person who requires 4 or more hours of mechanical ventilation a day for more than 1 month. This statement provides principles and guidelines for (1) selection of VAIs for discharge from the ICU to sites other than the ICU, and (2) management of VAIs at non-ICU sites in the United States.

Objectives for Management of a VAI at Non-ICU Sites

• Treat the patient's acute illness, prevent acute decompensation and clinical instability.
• Wean the patient from mechanical ventilation, when medically appropriate.
• Enhance the patient's quality of life.

The acuteness and severity of the patient's pathophysiologic process(es) determine the application of management objectives. For example, weaning from mechanical ventilation is an objective only when a patient is medically stable.

Goals for Management of a VAI at Non-ICU Sites

Provide an environment that enhances the individual's potential.

• Improve physical and physiologic function.
• Reduce morbidity.
• Extend life.
• Provide cost-effective care.

Each of the above goals can be applied equally to each of the above objectives.

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