ICU成人患者早期活动临床实践指南、专家共识的质量评价和内容分析

Quality evaluation and content analysis of clinical practice guideline and expert consensus on early activities for ICU adult patients

目的对国内外发布的ICU成人患者早期活动临床实践指南和专家共识进行质量评价,为规范化构建我国ICU成人患者早期活动方案提供借鉴和参考依据。方法计算机系统检索国内外临床实践指南网站、康复专业相关网站及各数据库发布的ICU成人患者早期活动的临床实践指南和专家共识,检索时限为建库至2020年7月31日。由2名研究者应用临床指南研究与评估系统Ⅱ和澳大利亚Joanna Briggs Institute(JBI)循证卫生保健中心针对文章质量评价的标准分别对指南和专家共识进行质量评价。结果最终纳入临床实践指南8篇,专家共识12篇。指南总体质量评价为7篇B级,1篇C级。专家共识经质量评价后均可纳入研究且真实性较高。ICU成人患者早期活动的相关推荐意见涉及早期活动的安全性和可行性;早期活动准备和监测指标;早期活动的启动指标;早期活动暂停指标;早期活动强度、时间;预后测量指标6个方面。结论ICU成人患者早期活动临床实践指南和专家共识的总体质量一般,指南的严谨性、清晰性、应用性及独立性有待提高,国内学者应重视临床实践指南的制订和应用,借鉴国外高质量证据进行本土化实践,指导我国危重症康复领域的发展。

Objective To evaluate quality of clinical practice guidelines and expert consensus on early activities of ICU adult patients issued at home and abroad,so as to provide reference for the standardized construction of the early activity program for ICU adult patients in China.Methods Clinical practice guidelines and expert consensus on early activities for ICU adult patients published at home and abroad on clinical practice guide websites,rehabilitation professional related websites and various databases were searched by computer system.The retrieval time was from the establishment of databases to July 31,2020.Two researchers applied Clinical Guidelines Research and Evaluation System Ⅱ and the Joanna Briggs Institute(JBI)Evidence-based Health Care Center in Australia to evaluate guidelines and expert consensus on the standards of article quality evaluation,respectively.Results Finally,a total of 8 clinical practice guidelines and 12 expert consensuses were included.The overall quality evaluation of the guideline was grade B for 7 articles and grade C for 1 article.Expert consensus could be included in the study after quality evaluation,and the authenticity was high.Recommendations on early activities for ICU adult patients involved six aspects,such as safety and feasibility of early activities,preparation and monitoring indicators of early activities,start indicators of early activities,suspension indicators of early activities,intensity and time of early activities and prognostic measurement indicators.Conclusions The overall quality of the clinical practice guidelines and expert consensus for early activities for ICU adult patients is average,and the rigor,clarity,applicability and independence of guidelines need to be improved.Domestic scholars should pay attention to the formulation and application of clinical practice guidelines,learn from foreign high-quality evidence for localized practice and guide development of critical illness rehabilitation field in China.