成人危重症患者误吸预防与管理的最佳证据总结

Prevention and management of aspiration in critically ill adult patients:a summary of the best evidence

目的 系统检索、评价及整合成人危重症患者误吸预防与管理的相关证据,并汇总形成最佳证据,为误吸的预防与管理提供依据。方法 遵照“6S”金字塔模型,自上而下系统检索BMJ Best Practice,UpToDate,澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库,加拿大安大略省注册护士协会,国际指南协作网,美国指南网,英国国家卫生与临床优化研究所,苏格兰校际指南网,PubMed,Embase,Cochrane Library,CINAHL,中国临床指南文库,医脉通,中国生物医学文献数据库,中国知网,万方数据库和维普数据库。纳入有关危重症患者误吸预防与管理的临床决策、指南、证据总结、专家共识/专家推荐、系统评价/Meta分析、随机对照试验,检索时限为2013年1月至2023年8月。由2名接受过循证护理学培训的研究者独立进行文献筛选、质量评价、证据提取与整合。结果 共纳入33篇研究,包括临床决策4篇、指南4篇、证据总结5篇、专家共识8篇、系统评价/Meta分析9篇、随机对照试验3篇。涉及误吸风险评估、气道管理、口腔卫生管理、体位管理、肠内营养管理、药物管理与干预、拔管后误吸的预防、误吸的诊断与处理、误吸培训与团队管理9个方面,共36条证据。结论 该证据总结可为医护人员对危重症患者误吸的预防及管理工作提供循证依据,促进ICU误吸的科学、规范化管理。

Objective To systematically retrieve,evaluate and integrate the best evidence on the prevention and management of aspiration in critically ill adult patients and had it summarised to form the best evidence so as to provide an evidence-based reference for prevention and management of aspiration.Methods Following the"6S"pyramid model,literatures on prevention and management of aspiration in critically ill adult patients published from January 2013 to August 2023,were retrieved from databases of BMJ Best Practice,UpToDate,Joanna Briggs Institute Evidence-Based Healthcare Centre in Australia,College of Nurses of Ontario in Canada,International Guideline Network,Guidelines.gov of the United States,National Institute for Health and Care Excellence,Scottish Intercollegiate Guidelines Network,PubMed,Embase,Cochrane Library,CINAHL,Chinese Clinical Practice Guidelines Library,Medlive,Chinese Biomedical Literature Database,CNKI,Wanfang Data and VIP.The retrieved data included clinical decisions,guidelines,evidence summaries,expert consensus/recommendations,systematic reviews/meta-analyses,and randomised controlled trials regarding the prevention and management of aspiration in critically ill adult patients.Two researchers who were trained in evidence-based nursing independently conducted literature selection,quality assessment,evidence extraction and synthesis.Results A total of 33 articles were included,with 4 clinical decisions,4 guidelines,5 evidence summaries,8 expert consensuses,9 systematic reviews/meta analysis and 3 randomised controlled trials.Eventually,36 points of best evidence were summarised from 9 themes,namely aspiration risk assessment,airway management,oral hygiene management,positioning management,enteral nutrition management,drug management and prevention,diagnosis and treatment of aspiration,prevention of post-extubation aspiration,aspiration training,and team management.Conclusions This evidence summary can provide healthcare workers with evidence-based support for prevention and management of aspiration in ICU,which will make ICU nursing more scientific and standard.