Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review.
Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review.
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DOI：
10.1097/pcc.0000000000003025
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发表时间：
2022-12-01
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影响因子：
--
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中科院分区：
文献类型：
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使用现实主义和元叙述证据综合：不断发展的标准出版标准，绘制小儿呼吸衰竭通气释放实践的证据。CINAHL、MEDLINE、科克伦和EMBASE。试验登记册包括：ClinicalTrials.gov、欧洲联盟临床试验登记册、国际标准化随机对照试验编号登记册。筛选摘要，然后审查全文。评估了以英语发表的包含婴儿和年龄较大儿童的异质人群的文章。一个也没有。脱机可以被认为是正压降低的过程，并且患者越来越多地负责产生有效气体交换所需的能量。随着无创呼吸支持的使用越来越多，如果在拔管后使用一些额外的正压，拔管可以位于脱机过程的中间，而对于某些拔管可能构成脱机的结束。拔管准备测试是脱机过程的关键组成部分，因为它允许重症监护医生评估患者呼吸系统恢复无辅助通气的能力和耐力。自主呼吸试验（SBT）通常被视为拔管准备测试（ERT），但SBT用于确定患者是否可以在最小的辅助支持下保持足够的自主通气，而ERT则意味着患者已准备好拔管。目前的文献表明，使用结构化的方法，包括每天评估患者的拔管准备可能会减少总通气时间。越来越多的证据表明，这种日常评估需要包括SBT，而不需要额外的压力支持。负荷升高和呼吸肌功能受损与儿童拔管失败独立相关，表明这些也应该作为ERT的一部分进行评估。
To map the evidence for ventilation liberation practices in pediatric respiratory failure using the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards. CINAHL, MEDLINE, COCHRANE, and EMBASE. Trial registers included the following: ClinicalTrials.gov, European Union clinical trials register, International Standardized Randomized Controlled Trial Number register. Abstracts were screened followed by review of full text. Articles published in English language incorporating a heterogeneous population of both infants and older children were assessed. None. Weaning can be considered as the process by which positive pressure is decreased and the patient becomes increasingly responsible for generating the energy necessary for effective gas exchange. With the growing use of noninvasive respiratory support, extubation can lie in the middle of the weaning process if some additional positive pressure is used after extubation, while for some extubation may constitute the end of weaning. Testing for extubation readiness is a key component of the weaning process as it allows the critical care practitioner to assess the capability and endurance of the patient’s respiratory system to resume unassisted ventilation. Spontaneous breathing trials (SBTs) are often seen as extubation readiness testing (ERT), but the SBT is used to determine if the patient can maintain adequate spontaneous ventilation with minimal ventilatory support, whereas ERT implies the patient is ready for extubation. Current literature suggests using a structured approach that includes a daily assessment of patient’s readiness to extubate may reduce total ventilation time. Increasing evidence indicates that such daily assessments needs to include SBTs without added pressure support. Measures of elevated load as well as measures of impaired respiratory muscle capacity are independently associated with extubation failure in children, indicating that these should also be assessed as part of ERT.
影响因子：
2.9
作者：
Garcia, Amanda Alves Assis;Vieira, Alexia Gabriela da Silva;Kuramoto, Danielle Akemi Bergara;Leite, Ilana Gomes;de Freitas, Thais Rodrigues;Reicher, Marcello Erich;Trevisani, Virginia Fernandes Moca;Guedes Neto, Henrique Jorge;Flumignan, Ronald Luiz Gomes;de Amorim, Jorge Eduardo;Nakano, Luis Carlos Uta
通讯作者：
Nakano, Luis Carlos Uta