Nosocomial Pneumonia in the ICU: Still More Questions Than Answers.
Nosocomial Pneumonia in the ICU: Still More Questions Than Answers.
复制标题
ICU 中的院内肺炎：问题仍然多于答案。
DOI：
10.1097/ccm.0000000000003600
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发表时间：
2019
影响因子：
8.8
通讯作者：
J. Cobb
中科院分区：
文献类型：
--
作者：
M. Schellenberg;J. Cobb
472 www.ccmjournal.org 2019 年 3 月 • 第 47 卷 • 针对这一重要主题的第 3 项调查可能会探讨这些问题和其他问题。很少有单项研究的构建和实施如此出色，以至于可以被重症监护界采用而无需重复 (6)。这是一个越来越受到重视的重要概念，Bertrand 等人 (1) 目前的研究当然需要根据这些原则 (6) 进行复制，并在不同的卫生系统中进行复制。当证据严重有限且偏倚风险很高时，过早长期采用有希望的初步研究可能会将多余的仪式引入临床实践（7）。独立于复制，患者自主这一重要课题应该进一步细致、发展和探索，最终目标是协助一线临床医生为患者提供更好的护理。在此期间，必须判断是否将 Bertrand 等人 (1) 的研究结果作为临时措施采用到临床实践中，同时收集和评估进一步的证据，或者非正式评估是否仍然是首选实践。鉴于这项精心进行的初步研究的结果与其他医疗保健环境中的其他研究的证据相结合，在我们等待这一研究领域的进一步进展的同时，采用本研究中概述的对患者决策能力的正式评估作为首选的临时护理标准似乎是合理且合乎逻辑的。这似乎是获得患者自主权的最佳机会。
472 www.ccmjournal.org March 2019 • Volume 47 • Number 3 investigations into this important topic may explore these and other issues. Few single studies are so well constructed and conducted that they should be adopted by the critical care community without being replicated (6). This is an important concept that is increasingly being appreciated, and the current study by Bertrand et al (1) certainly needs to be replicated according to these principles (6) and replicated in different health systems. Premature long-term adoption of promising preliminary studies risk introducing redundant ritual into clinical practice when the evidence is seriously limited with a high risk of bias (7). Independent of replication, this important subject of patient autonomy should be further nuanced, developed, and explored with the ultimate goal of assisting frontline clinical practitioners to provide better care for their patients. In the interim, a judgment has to be made whether to adopt the findings of the study by Bertrand et al (1) into clinical practice as a temporary measure while further evidence is gathered and evaluated or whether informal assessment is still preferred practice. Given the results of this carefully conducted preliminary study combined with evidence from other studies in other healthcare contexts, it seems reasonable and logical to adopt formal assessment of patients’ decision-making capacities as outlined in the present study as the preferred temporary standard of care while we await further advancements in this field of study. This would seem to give the best chance of getting patient autonomy right.