Promoting Evidence-Based Practice in Acute Respiratory Distress Syndrome: A Systematic Review.
Promoting Evidence-Based Practice in Acute Respiratory Distress Syndrome: A Systematic Review.
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DOI：
10.1097/cce.0000000000000391
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发表时间：
2021-04
影响因子：
--
通讯作者：
Hough CL
中科院分区：
文献类型：
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作者：
Giovanni SP;Jennerich AL;Steel TL;Lokhandwala S;Alhazzani W;Weiss CH;Hough CL
文本中提供了补充数字内容。低潮气量通气和俯卧位是推荐的治疗方法，但未充分用于急性呼吸窘迫综合征。我们的目的是评估干预措施的作用，重点是实施低潮气量通气和俯卧位的机械通气成人急性呼吸窘迫综合征患者。PubMed、Excerpta Medica Database、Cumulative Index to Nursing and Allied Health Literature和科克伦对照试验中心注册库。我们检索了2001年1月1日至2021年1月28日期间的4个数据库，以查找符合预定义检索标准的研究。选定的研究集中在改善急性呼吸窘迫综合征机械通气患者低潮气量通气和俯卧位实施的干预措施。两位作者使用标准化表格独立进行研究选择和数据提取。由于纳入研究的方法学异质性，荟萃分析不可行;因此，我们提供了文献的叙述性总结和评估。8项非随机研究符合我们的合格标准。大多数研究着眼于干预措施，以提高低潮气量通气的依从性。大多数干预措施侧重于对提供者的教育。研究主要在ICU进行，涉及受训人员、重症监护医生、呼吸治疗师和重症监护护士。尽管研究的总体质量非常低，但主要结果表明，干预措施可以改善急性呼吸窘迫综合征中低潮气量通气和俯卧位的依从性或实施。两位作者使用标准化表格独立进行研究选择和数据提取。由于纳入研究的方法学异质性，荟萃分析不可行;因此，我们提供了文献的叙述性总结和评估。8项非随机研究符合我们的合格标准。大多数研究着眼于干预措施，以提高低潮气量通气的依从性。大多数干预措施侧重于对提供者的教育。研究主要在ICU进行，涉及受训人员、重症监护医生、呼吸治疗师和重症监护护士。尽管研究的总体质量非常低，但主要关注结果表明，干预措施可以改善急性呼吸窘迫综合征患者低潮气量通气和俯卧位的依从性或实施。目前缺乏关于干预措施以改善急性呼吸窘迫综合征循证实践实施的文献。现有的干预措施，以提高临床医生的知识和促进应用低潮气量通气和俯卧位可能是有效的，但支持研究有显着的局限性。
Supplemental Digital Content is available in the text. Low tidal volume ventilation and prone positioning are recommended therapies yet underused in acute respiratory distress syndrome. We aimed to assess the role of interventions focused on implementation of low tidal volume ventilation and prone positioning in mechanically ventilated adult patients with acute respiratory distress syndrome. PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials. We searched the four databases from January 1, 2001, to January 28, 2021, for studies that met the predefined search criteria. Selected studies focused on interventions to improve implementation of low tidal volume ventilation and prone positioning in mechanically ventilated patients with acute respiratory distress syndrome. Two authors independently performed study selection and data extraction using a standardized form. Due to methodological heterogeneity of included studies, meta-analysis was not feasible; thus, we provided a narrative summary and assessment of the literature. Eight nonrandomized studies met our eligibility criteria. Most studies looked at interventions to improve adherence to low tidal volume ventilation. Most interventions focused on education for providers. Studies were primarily conducted in the ICU and involved trainees, intensivists, respiratory therapists, and critical care nurses. Although overall quality of the studies was very low, the primary outcomes of interest suggest that interventions could improve adherence to or implementation of low tidal volume ventilation and prone positioning in acute respiratory distress syndrome. Two authors independently performed study selection and data extraction using a standardized form. Due to methodologic heterogeneity of included studies, meta-analysis was not feasible; thus, we provided a narrative summary and assessment of the literature. Eight nonrandomized studies met our eligibility criteria. Most studies looked at interventions to improve adherence to low tidal volume ventilation. Most interventions focused on education for providers. Studies were primarily conducted in the ICU and involved trainees, intensivists, respiratory therapists, and critical care nurses. Although overall quality of the studies was very low, the primary outcomes of interest suggest that interventions could improve adherence to or implementation of low tidal volume ventilation and prone positioning in acute respiratory distress syndrome. There is a dearth of literature addressing interventions to improve implementation of evidence-based practices in acute respiratory distress syndrome. Existing interventions to improve clinician knowledge and facilitate application of low tidal volume ventilation and prone positioning may be effective, but supporting studies have significant limitations.