MacIntyre Neil R, Epstein Scott K, Carson Shannon, Scheinhorn David, Christopher Kent, Muldoon Sean
Duke University Medical Center, Durham, NC 27710, USA.
Chest. 2005 Dec;128(6):3937-54. doi: 10.1378/chest.128.6.3937.
Patients requiring prolonged mechanical ventilation (PMV) are rapidly increasing in number, as improved ICU care has resulted in many patients surviving acute respiratory failure only to then require prolonged mechanical ventilatory assistance during convalescence. This patient population has clearly different needs and resource consumption patterns than patients in acute ICUs, and specialized venues, management strategies, and reimbursement schemes for them are rapidly emerging. To address these issues in a comprehensive way, a conference on the epidemiology, care, and overall management of patients requiring PMV was held. The goal was to not only review existing practices but to also develop recommendations on a variety of assessment, management, and reimbursement issues associated with patients requiring PMV. Formal presentations were made on a variety of topics, and writing groups were formed to address three specific areas: epidemiology and outcomes, management and care settings, and reimbursement. Each group was charged with summarizing current data and practice along with formulation of recommendations. A working draft of the products of these three groups was then created and circulated among all participants. The document was reworked with input from all concerned until a final product with consensus recommendations on 12 specific issues was achieved.
由于重症监护病房（ICU）护理水平的提高，许多患者在急性呼吸衰竭后得以存活，但在康复期间需要长期机械通气支持，因此需要长期机械通气（PMV）的患者数量正在迅速增加。与急性ICU患者相比，这一患者群体的需求和资源消耗模式明显不同，针对他们的专门场所、管理策略和报销方案正在迅速涌现。为了全面解决这些问题，召开了一次关于需要PMV患者的流行病学、护理和整体管理的会议。会议的目标不仅是回顾现有做法，还要就与需要PMV患者相关的各种评估、管理和报销问题提出建议。会上就各种主题进行了正式发言，并成立了写作小组来处理三个具体领域的问题：流行病学和结果、管理和护理环境以及报销。每个小组负责总结当前数据和实践，并制定建议。然后创建了这三个小组成果的工作草案，并在所有参与者中传阅。在所有相关方的意见输入下，对该文件进行了修订，直到就12个具体问题达成了具有共识性建议的最终文件。
