目的检索、评价和总结成人ARDS俯卧位机械通气患者压力性损伤预防的证据,为临床护士对成人ARDS俯卧位机械通气患者压力性损伤的管理提供依据。方法系统检索UpToDate、BMJ Best Practice、国际指南协作网、美国指南网、英国国家健康学会...目的检索、评价和总结成人ARDS俯卧位机械通气患者压力性损伤预防的证据,为临床护士对成人ARDS俯卧位机械通气患者压力性损伤的管理提供依据。方法系统检索UpToDate、BMJ Best Practice、国际指南协作网、美国指南网、英国国家健康学会、Joanna Briggs Institute(JBI)循证卫生保健中心、Cochrane Library、医脉通、EMBASE、PubMed、BMJ、CNKI、万方数据库、中国生物医学文献服务系统中关于成人ARDS俯卧位机械通气患者压力性损伤预防的证据,包括临床决策、指南、证据总结、系统评价、Meta分析、RCT及类试验研究。检索时限为2010年12月1日—2020年12月1日。由4名人员进行文献质量评价,由2名人员对纳入的文献进行提取和汇总。结果最终纳入7篇文献,1篇临床决策、3篇指南、2篇RCT、1篇类试验研究。从评估、干预措施、监管、护理人员专业知识培训及预防遵循原则5个方面,提取出12条证据。结论本研究总结的成人ARDS俯卧位机械通气患者压力性损伤预防的最佳证据便于临床护理人员对患者进行更具针对性、科学性的压力性损伤的评估及护理。展开更多
Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome （ALI/ARDS） usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health ...Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome （ALI/ARDS） usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care workers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxygenation without use of expensive, invasive and exprimental procedures. Prone positioning is a safe and effective way to improve ventilation when conventional strategies fail to initiate a patient response. Because a specific cure for ARDS is not available, the goat is to support the patients with therapies that cause the least amount of injury while the lungs have an opportunity to heat. Based on current data, a trial of prone positioning ventilation should be offeted to the patients who have ALI/ARDS in the early course of the disease. Published studies exhibit substantial heterogeneity in clinical results, suggesting that an adequately sized study optimizing the duration of pronmg ventilation strategy is warranted to enable definitive conclusions to be drawn.展开更多
Background： Over the years, the mechanical ventilation （MV） strategy has changed worldwide. The aim of the present study was to describe the ventilation practices, particularly lung-protective ventilation （LPV）, ...Background： Over the years, the mechanical ventilation （MV） strategy has changed worldwide. The aim of the present study was to describe the ventilation practices, particularly lung-protective ventilation （LPV）, among brain-injured patients in China. Methods： This study was a multicenter, 1-day, cross-sectional study in 47 Intensive Care Units （ICUs） across China. Mechanically ventilated patients （18 years and older） with brain injury in a participating ICU during the time of the study, including traumatic brain injury, stroke, postoperation with intracranial tumor, hypoxic-ischemic encephalopathy, intracranial infection, and idiopathic epilepsy, were enrolled. Demographic data, primary diagnoses, indications for MV, MV modes and settings, and prognoses on the 60th day were collected. Multivariable logistic analysis was used to assess factors that might affect the use of LPV. Results： A total of 104 patients were enrolled in the present study, 87 （83.7%） of whom were identified with severe brain injury based on a Glasgow Coma Scale 〈8 points. Synchronized intermittent mandatory ventilation （SIMV） was the most frequent ventilator mode, accounting for 46.2% of the entire cohort. The median tidal volume was set to 8.0 ml/kg （interquartile range [IQR], 7.0-8.9 ml/kg） of the predicted body weight; 50 （48.1%） patients received LPV. The median positive end-expiratory pressure （PEEP） was set to 5 cmH20 （IQR, 5-5 cmH20）. No PEEP values were higher than 10 cmH20. Compared with partially mandatory ventilation, supportive and spontaneous ventilation practices were associated with LPV. There were no significant differences in mortality and MV duration between patients subjected to LPV and those were not. Conclusions： Among brain-injured patients in China, SIMV was the most frequent ventilation mode. Nearly one-half of the brain-injured patients received LPV. Patients under supportive and spontaneous ventilation were more likely to receive LPV.展开更多
文摘Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome （ALI/ARDS） usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care workers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxygenation without use of expensive, invasive and exprimental procedures. Prone positioning is a safe and effective way to improve ventilation when conventional strategies fail to initiate a patient response. Because a specific cure for ARDS is not available, the goat is to support the patients with therapies that cause the least amount of injury while the lungs have an opportunity to heat. Based on current data, a trial of prone positioning ventilation should be offeted to the patients who have ALI/ARDS in the early course of the disease. Published studies exhibit substantial heterogeneity in clinical results, suggesting that an adequately sized study optimizing the duration of pronmg ventilation strategy is warranted to enable definitive conclusions to be drawn.
文摘Background： Over the years, the mechanical ventilation （MV） strategy has changed worldwide. The aim of the present study was to describe the ventilation practices, particularly lung-protective ventilation （LPV）, among brain-injured patients in China. Methods： This study was a multicenter, 1-day, cross-sectional study in 47 Intensive Care Units （ICUs） across China. Mechanically ventilated patients （18 years and older） with brain injury in a participating ICU during the time of the study, including traumatic brain injury, stroke, postoperation with intracranial tumor, hypoxic-ischemic encephalopathy, intracranial infection, and idiopathic epilepsy, were enrolled. Demographic data, primary diagnoses, indications for MV, MV modes and settings, and prognoses on the 60th day were collected. Multivariable logistic analysis was used to assess factors that might affect the use of LPV. Results： A total of 104 patients were enrolled in the present study, 87 （83.7%） of whom were identified with severe brain injury based on a Glasgow Coma Scale 〈8 points. Synchronized intermittent mandatory ventilation （SIMV） was the most frequent ventilator mode, accounting for 46.2% of the entire cohort. The median tidal volume was set to 8.0 ml/kg （interquartile range [IQR], 7.0-8.9 ml/kg） of the predicted body weight; 50 （48.1%） patients received LPV. The median positive end-expiratory pressure （PEEP） was set to 5 cmH20 （IQR, 5-5 cmH20）. No PEEP values were higher than 10 cmH20. Compared with partially mandatory ventilation, supportive and spontaneous ventilation practices were associated with LPV. There were no significant differences in mortality and MV duration between patients subjected to LPV and those were not. Conclusions： Among brain-injured patients in China, SIMV was the most frequent ventilation mode. Nearly one-half of the brain-injured patients received LPV. Patients under supportive and spontaneous ventilation were more likely to receive LPV.
