ICU气管插管患者拔管指南的质量评价与内容分析

Quality evaluation and content analysis of guidelines of airway extubation for adult patients in ICU

目的 对ICU气管插管患者拔管相关指南进行质量评价和内容分析,为国内指南的制订提供循证依据。方法 系统检索国内外指南网站、相关专业学会网站及中英文数据库,检索时限为建库至2021年8月,并根据纳入和排除标准进行文献筛选。2名研究者采用质量评价工具对纳入的指南进行质量评价,并对相应的推荐意见进行汇总分析。结果 最终纳入8篇指南,均来自国外,其中4篇为A级,4篇为B级,整体质量较高。将ICU气管插管患者拔管的推荐意见归纳为拔管前评估、制订拔管计划、拔管前准备、实施拔管、拔管后处理、减少并发症的措施和特殊人群的应对7个方面33项内容。结论 ICU气管插管患者拔管相关指南整体质量较高,但部分推荐意见尚有争议,有待构建本土化循证指南以指导临床实践。

Objective To evaluate the quality and analyze the content of existing guidelines related to airway extubation in adult ICU patients,in order to provide evidence-based bases for the formulation of domestic guidelines. Methods Electronic resources,including websites of international guidelines,related organization websites and biomedical databases,were retrieved from inception to August 31st 2021. 2 reviewers independently evaluated the quality of the included guidelines by the appraisal of guidelines for research & evaluation Ⅱ reporting checklist(AGREE Ⅱ),and then analyzed and summarized the contents of the recommendations of each guideline. Results A total of 8 guidelines were included,4 of which were rated level A and the rest 4 were rated level B. Recommendations involved 7 aspects,namely pre-extubation evaluation,making plans,pre-extubation preparation,implementation of extubation,post-extubation treatment,adverse reaction reduction and the treatment of special groups.Conclusion The overall quality of the included guidelines is high. However,there is a lack of guidelines specifically for ICU patients,and some recommendations are controversial. Local evidence-based guidelines in China should be developed to guide the implementation of airway extubation in adult ICU patients.