ICU成人患者有创机械通气撤机的最佳证据总结

Best Evidence Summary for Weaning from Mechanical Ventilation of Adult Patients in Intensive Care Unit

目的评价总结ICU成人患者有创机械通气撤机的证据,为护理人员提供临床实践准则。方法基于PIPOST模式确定循证问题,检索ICU成人患者有创机械通气撤机的相关证据,并从中筛选符合纳入标准的相关文献,由课题组研究人员(均经过循证培训)对所纳入的循证文献进行质量评价和资料提取,对符合质量标准的文献进行证据的归纳总结。结果共纳入证据12篇,包括临床决策3篇、指南4篇、证据总结2篇、系统评价3篇。汇总提取4个维度25条最佳证据,各维度分别为撤机筛查评估、撤机方案实施、气管导管拔除、人员组织管理。结论撤机是一个动态、复杂的过程,临床应制定适合本科室的撤机方案,强化对医护人员撤机知识、方案、程序的规范化培训,以提高撤机成功率,缩短机械通气时间。

Objective To evaluate and summarize the best evidence for weaning from mechanical ventilation of adult patients in intensive care unit.Methods Evidence-based problems were determined based on the PIPOST pattern then we electronically retrieved the research on the weaning from mechanical ventilation.Reviewers independently assessed the quality and extracted the data in the included studies.Evidence was summarized from eligible studies.Results Twelve articles were included,with 3 clinical decisions,4 guidelines,2 best evidence summary and 3 systematic reviews.Evidence was extracted and summarized into 25 items,which were classified into 4 categories including:assessment of weaning screening,weaning protocol implementing,tracheal tube extraction and organizational administration.Conclusion Weaning from mechanical ventilation of adult patients in intensive care unit is a dynamic and complicated process.A practical weaning program,and standardized training for medical staff on weaning knowledge,program and procedure are conducive to the success of weaning thus to improve clinical outcome.