Saudi Guideline for Mechanical Ventilation in Adults

Background: Mechanical ventilation is a critical intervention for patients with respiratory failure. Recent advancements and quality improvement initiatives in Saudi Arabia have contributed to refining mechanical ventilation practices. This guideline represents the first national evidence-based framework developed through a multidisciplinary approach. Objectives: This guideline provides evidence-based recommendations for the management of mechanically ventilated adults in intensive care units in Saudi Arabia, incorporating best practices to improve patient outcomes and standardize care across healthcare institutions. Methods: The guideline development followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT methodology, an internationally accepted approach for adopting, adapting, and developing guidelines. A multidisciplinary task force, comprising intensivists, pulmonologists, anaesthesiologists, respiratory therapists, and nursing specialists, conducted a systematic review of the literature and contextualized recommendations for local healthcare settings. The guideline addressed 14 prioritized questions. Results: The guideline included strong recommendations for using low tidal volume ventilation for patients with ARDS, utilizing higher levels of positive end-expiratory pressure, and employing head-of-bed elevation. The guideline provided conditional recommendations for using veno-venous extracorporeal membrane oxygenation, daily sedation interruption, protocolized spontaneous breathing trials, prone positioning, using an endotracheal tube with subglottic secretion drainage, using light sedation, and early tracheostomy. The guideline also included a conditional recommendation against using nitric oxide and a neutral recommendation regarding recruitment maneuvers and early mobility. Conclusion: This guideline serves as a foundational framework for optimizing mechanical ventilation practices in Saudi Arabia. Future research should focus on local implementation strategies, cost-effectiveness analysis, and the impact of guideline adherence on clinical outcomes.