基于指南和RCT研究的ICU成人机械通气患者气管插管拔管管理的最佳证据总结  

Summary of the best evidence for the management of endotracheal intubation and extubation in adult mechanically ventilated patients in intensive care unit based on guidelines and randomized controlled trials

作　　者：刘秀梅[1] 龚平[2] 康健[2] 贺素蕊 Liu Xiumei;Gong Ping;Kang Jian;He Surui(Department of ICU,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,Liaoning,China;Department of EICU,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,Liaoning,China)

机构地区：[1]大连医科大学附属第一医院重症医学科,辽宁大连116011 [2]大连医科大学附属第一医院急诊ICU,辽宁大连116011

出　　处：《中华危重病急救医学》2021年第8期927-932,共6页Chinese Critical Care Medicine

基　　金：辽宁省教育厅科研经费项目(LZ2019007)。

摘　　要：目的总结重症监护病房(ICU)成人机械通气患者气管插管拔管管理的最佳证据,为临床医护人员提供实践准则。方法系统检索BMJ最佳临床实践、UpToDate临床顾问、国际指南协作网、美国国立临床诊疗指南数据库、英国国家卫生与临床优化研究所、苏格兰学院间指南网、加拿大安大略省注册护士协会网站、医脉通临床指南、Cochrane图书馆、JBI循证卫生保健中心数据库、科学网、美国国立医学图书馆数据库(PubMed)、护理和联合卫生文献累积索引数据库、Ebsco全文数据库、中国生物医学文献服务系统(SinoMed)、中国知网、万方数据库等,从建库至2020年8月31日公开发表的临床指南、系统评价、专家共识和随机对照试验(RCT)研究。采用临床实践指南研究与评价系统Ⅱ(AGREEⅡ)、JBI循证卫生保健中心2016质量评价工具和Cochrane风险偏倚评估工具,由2名研究者分别对纳入文献进行质量评价,进而提取ICU成人机械通气患者气管插管拔管管理的最佳证据并进行总结。结果共纳入12篇文献,包括2篇指南、5篇系统评价、2篇专家共识及3篇RCT研究,总结ICU成人机械通气患者气管插管拔管管理的最佳证据17条,包括准确的拔管前评估,人员设备配备,用药、体位、氧疗、气道管理以及拔管后监测等7个方面的内容。结论医护人员应选择符合临床实际情况的最佳证据,规范气管插管拔管患者的管理,以降低并发症发生率及再插管率,保障患者安全,这将对ICU成人机械通气患者气管插管拔管管理具有重要指导意义。Objective To summarize the best evidence for extubation management of adult patients with mechanical ventilation in the intensive care unit(ICU),which will provide practical guidelines for medical staffs.Methods BMJ best clinical practice,UpToDate clinical consultants,Guidelines International Network(GIN),National Guideline Clearinghouse(NGC),National Institute for Health and Care Excellence(NICE),Scottish Intercollegiate Guidelines Network(SIGN),Registered Nurses'Association of Ontario(RNAO),Medlive guide,Cochrane Library,JBI evidence-based Health Care Center Database,Web of Science,PubMed,Cumulative Index to Nursing and Allied Health Literature(CINAHL),Ebsco,SinoMed,CNKI,Wanfang Database,etc.,were systematically searched.Clinical guidelines,systematic reviews,expert consensus,and randomized controlled trial(RCT)studies were searched from the above database unit August 31st,2020.Literature quality was evaluated using Appraisal of Guidelines for Research and EvaluationⅡ(AGREEⅡ),JBI quality evaluation tools,and Cochrane risk bias assessment.Two researchers evaluated the quality of the included literature respectively,and then the best evidence of endotracheal intubation and extubation management in ICU adult patients with mechanical ventilation was extracted and summarized.Results A total of 12 articles were collected,including 2 guidelines,5 systematic reviews,2 expert consensus,and 3 RCTs.This paper summarizes 17 best evidences on extubation management of adult patients with mechanical ventilation in ICU,including accurate pre-extubation assessment,personnel and equipment,medication,posture,oxygen therapy,airway management,and post-extubation monitoring.Conclusion Medical staff should choose the best evidence that meets the requirements of the clinical settings and standardize the management of patients after extubation to reduce the incidence of complications and re-intubation rate to ensure the safety of patients,which will be very important for the management of ICU adult patients with mechanical ventilat

关 键 词：重症监护病房 机械通气 成人 气管插管 拔管 

分 类 号：R459.7[医药卫生—急诊医学]