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机械通气危重症患者的脱机
美国胸科医师协会(ACCP) / 美国胸科学会(ATS)官方临床实践指南概要

Gregory A. Schmidt, MD, FCCP; Timothy D. Girard, MD; John P. Kress, MD, FCCP; Peter E. Morris, MD, FCCP; Daniel R. Ouellette, MD, FCCP; Waleed Alhazzani, MD; Suzanne M. Burns, RN, MSN, ACNP, RRT; Scott K. Epstein, MD, FCCP; Andres Esteban, MD, PhD; Eddy Fan, MD, PhD; Miguel Ferrer, MD, PhD; Gilles L. Fraser, PharmD; Michelle Ng Gong, MD; Catherine L. Hough, MD; Sangeeta Mehta, MD; Rahul Nanchal, MD, FCCP; Sheena Patel, MPH; Amy J. Pawlik, DPT; William D. Schweickert, MD; Curtis N. Sessler, MD, FCCP; Thomas Strøm, MD; Kevin C. Wilson, MD; and Jonathon D. Truwit, MD, FCCP

From the Division of Pulmonary, Critical Care &Occupational Medicine (Dr Schmidt), University of Iowa, Iowa City, IA; Department of Critical Care Medicine (Dr Girard), University of Pittsburgh School of Medicine, Pittsburgh, PA; Section of Pulmonary and Critical Care (Dr Kress), University of Chicago, Chicago, IL; Department of Pulmonary, Critical Care, and Sleep Medicine (Dr Morris), University of Kentucky, Lexington, KY; Department of Pulmonary Disease Service (Dr Ouellette), Henry Ford Hospital, Detroit, MI; Department of Medicine (Dr Alhazzani), McMaster University, Hamilton, ON, Canada; Department of Nursing (Ms Burns), University of Virginia Health System, Charlottesville, VA; Division of Pulmonary, Critical Care and Sleep Medicine (Dr Epstein), Tufts University School of Medicine, Boston, MA; Department of Intensive Care Unit (Dr Esteban), Hospital Universitario de Getafe, Madrid, Spain; Interdepartmental Division of Critical Care Medicine (Dr Fan) and Division of Respirology (Dr Mehta), University of Toronto, Toronto, ON, Canada; Department of Pneumology (Dr Ferrer), Respiratory Institute, Hospital Clinic, IDIBAPS, CibeRes (CB06/06/0028), University of Barcelona, Barcelona, Spain; Maine Medical Center (Dr Fraser), Portland, ME; Departments of Medicine and Epidemiology and Population Health (Dr Gong), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Division of Pulmonary and Critical Care Medicine (Dr Hough), Harborview Medical Center, University of Washington, Seattle, WA; Department of Pulmonary and Critical Care Medicine (Dr Nanchal), Medical College of Wisconsin, Milwaukee, WI; American College of Chest Physicians (Ms Patel), Glenview, IL; Department of Therapy Services (Dr Pawlik), University of Chicago Medical Center, Chicago, IL; Division of Pulmonary, Allergy and Critical Care (Dr Schweickert), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Internal Medicine, Division of Pulmonary and Critical Care (Dr Sessler), Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Anaesthesia and Intensive Care Medicine (Dr Strøm), University of Southern Denmark,Odense, Denmark; Pulmonary, Allergy, Sleep and Critical Care Medicine (Dr Wilson), Boston University, Boston, MA; and the Divison of Pulmonary and Critical Care Medicine (Dr Truwit), Froedtert and Medical College of Wisconsin, Milwaukee, WI.

CORRESPONDENCE TO: Jonathon D. Truwit, MD, FCCP, Froedtert and Medical College of Wisconsin, Froedtert Health Executive Office, 4th Flr, Clinical Cancer Center, Ste C4000, 9200 W Wisconsin Ave, Milwaukee, WI 53226; e-mail: jtruwit@mcw.edu

背景 本临床实践指南阐述了机械通气危重症患者脱机的6个问题。 这是美国胸科学会(ATS) 和美国胸科医师协会 (CHEST) 合作努力的结果。

方法 涵盖多学科的专家小组按PICO原则 (病人、 干预、 对比、 结果) 提出了6个临床问题。 对每个问题都进行全面的文献检索和证据整合, 其中包括采用GRADE (推荐、评估、 制定、 评价分级) 方法评估证据质量。 对每个问题均采用从证据到决策 (证据―决策) 的框架模式, 要求专家小组评估和权衡问题的重要性, 证据的可信度, 必然也包括主要成果的公共价值, 预期与非预期结果间的权重及平衡, 干预相关的资源和成本, 对健康影响的差异, 以及干预措施的可接受性和可行性。

结果 最初由小组委员会以循证医学证据为基础制定推荐意见及证据级别, 然后全小组成员共同讨论修正。 这些推荐意见通过机密电子表决的方式最终确定, 至少80%的小组成员赞同, 该建议方可批准通过。

结论 该专家小组制定了机械通气患者脱机相关的建议。 关于每个建议的证据和解释细节发表在AJRCCM和CHEST杂志。

缩略语 ATS = 美国胸科学会; CHEST = 美国胸科医师协会; CLT = 气囊漏气试验; GRADE = 推荐、评估、制定、评价分级; NIV = 无创通气; PES = 拔管后喘鸣; SBT = 自主呼吸试验

(郭禹标 译)
【英文原件请参阅 CHEST 2017;151(1):160–165】

 
 
         
     




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