神经外科气管切开患者拔管指征的最佳证据总结

Best evidence summary of indications for extubation in neurosurgical tracheotomy patients

目的检索并总结神经外科气管切开患者拔管指征的相关证据,为促进神经外科气管切开患者适时安全拔管提供参考。方法按照PIPOST模式确定循证问题,依据循证检索数据库的"6S"分类模型,系统检索数据库、指南网站和行业机构网站中神经外科气管切开患者拔管指征的所有证据,包括临床指南、系统评价、专家共识、证据总结和临床决策,检索时限为建库至2022年5月31日。由2名研究者独立对纳入文献进行质量评价和证据提取。结果共纳入12篇文献,包括指南4篇、系统评价4篇、专家共识2篇、证据总结1篇、临床决策1篇。共总结神经外科气管切开患者拔管指征最佳证据18条,包括病情、意识与自主活动、呼吸功能、咳嗽功能、吞咽功能、气道状况、多学科团队与设备保障7个主题。结论神经外科气管切开患者拔管需考虑多方面因素,证据总结具有一定的科学性与实用性,可为临床医护人员有针对性地开展证据应用提供循证依据。

Objective To retrieve and summarize the evidence of indications for extubation in neurosurgical tracheotomy patients,so as to provide reference for promoting timely and safe extubation of neurosurgical tracheotomy patients.Methods Evidence-based problems were identified according to the population,intervention,professional,outcome,setting,type of evidence(PIPOST)model.According to the"6S"classification model of the evidence-based retrieval database,all evidences of extubation indications of neurosurgical tracheotomy patients in the database,guideline website and professional institution website were systematically retrieved,including clinical guidelines,systematic review,expert consensus,evidence summary and clinical decision-making.The search period was from the establishment of the database to May 31,2022.Two researchers independently evaluated the quality of the included article and extracted evidence.Results A total of 12 articles were included,including four guidelines,four systematic reviews,two expert consensuses,one evidence summary,and one clinical decision-making.A total of 18 pieces of best evidence for extubation indications of neurosurgical tracheotomy patients were summarized,including 7 themes:disease condition,consciousness and autonomous activity,respiratory function,cough function,swallowing function,airway condition,multidisciplinary team and equipment support.Conclusions The extubation of neurosurgical tracheotomy patients should consider many factors.The summary of evidence has a certain degree of scientific and practical significance,which can provide evidence-based basis for medical and nursing staff to apply evidence in a targeted manner.