A Critique of the ACCP Consensus Conference on Mechanical Ventilation

The American College of Chest Physicians recently published a statement summarizing the results of the Consensus Conference on Mechanical Ventilation (Chest 1993; 104:1833-1859). In this statement, the physiology of mechanical ventilation was extensively reviewed, and 5 principles and 38 guidelines or recommendations on which consensus was reached were presented. The following critique (1) summarizes the findings of the conference; (2) comments on selected principles, recommendations, and physiological concepts presented in the statement; and (3) discusses the strengths and the limitations of the consensus conference format, as well as the errors and biases inherent in the policy-making process. The Consensus Conference statement is one of the clearest, most complete reviews of physiology and techniques of mechanical ventilation I have yet encountered. The suggested guidelines and recommendations clearly follow from the physiological principles discussed. Unfortunately, numerous problems with the consensus conference format and the almost total lack of controlled randomized studies limit the confidence with which these suggestions can be accepted. Our experts in respiratory care are remiss for not providing outcome-based or preference-based data, and the pulmonary and critical care community is remiss for not demanding that they do so before changing our approaches on the basis of their suggestions.