Research Centre for Clinical and Community Practice Innovation, Griffith University, Nathan, Queensland, Australia.
Crit Care Med. 2011 Jul;39(7):1800-18. doi: 10.1097/CCM.0b013e31821867cc.
To provide a series of recommendations based on the best available evidence to guide clinicians providing nursing care to patients with severe sepsis.
Modified Delphi method involving international experts and key individuals in subgroup work and electronic-based discussion among the entire group to achieve consensus.
We used the Surviving Sepsis Campaign guidelines as a framework to inform the structure and content of these guidelines. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system to rate the quality of evidence from high (A) to very low (D) and to determine the strength of recommendations, with grade 1 indicating clear benefit in the septic population and grade 2 indicating less confidence in the benefits in the septic population. In areas without complete agreement between all authors, a process of electronic discussion of all evidence was undertaken until consensus was reached. This process was conducted independently of any funding.
Sixty-three recommendations relating to the nursing care of severe sepsis patients are made. Prevention recommendations relate to education, accountability, surveillance of nosocomial infections, hand hygiene, and prevention of respiratory, central line-related, surgical site, and urinary tract infections, whereas infection management recommendations related to both control of the infection source and transmission-based precautions. Recommendations related to initial resuscitation include improved recognition of the deteriorating patient, diagnosis of severe sepsis, seeking further assistance, and initiating early resuscitation measures. Important elements of hemodynamic support relate to improving both tissue oxygenation and macrocirculation. Recommendations related to supportive nursing care incorporate aspects of nutrition, mouth and eye care, and pressure ulcer prevention and management. Pediatric recommendations relate to the use of antibiotics, steroids, vasopressors and inotropes, fluid resuscitation, sedation and analgesia, and the role of therapeutic end points.
Consensus was reached regarding many aspects of nursing care of the severe sepsis patient. Despite this, there is an urgent need for further evidence to better inform this area of critical care.
基于最佳现有证据提供一系列建议，以指导为严重脓毒症患者提供护理的临床医生。
采用改良 Delphi 方法，涉及国际专家和分组工作的关键人员，以及整个小组之间的基于电子的讨论，以达成共识。
我们使用存活脓毒症运动指南作为框架，为这些指南的结构和内容提供信息。我们使用推荐评估、制定与评估（GRADE）系统来评估证据质量，从高（A）到极低（D），并确定建议的强度，等级 1 表示在脓毒症人群中明确受益，等级 2 表示在脓毒症人群中对益处的信心较低。在所有作者之间没有完全达成一致的领域，我们进行了所有证据的电子讨论过程，直到达成共识。这个过程是独立于任何资金进行的。
提出了 63 条与严重脓毒症患者护理相关的建议。预防建议涉及教育、问责制、医院感染监测、手卫生以及预防呼吸道、中心静脉相关、手术部位和尿路感染，而感染管理建议则涉及感染源的控制和基于传播的预防措施。与初始复苏相关的建议包括更好地识别病情恶化的患者、诊断严重脓毒症、寻求进一步帮助和开始早期复苏措施。血流动力学支持的重要要素与改善组织氧合和宏观循环有关。与支持性护理相关的建议包括营养、口腔和眼部护理以及压疮预防和管理的各个方面。儿科建议涉及抗生素、类固醇、血管加压药和正性肌力药、液体复苏、镇静和镇痛以及治疗终点的作用。
就严重脓毒症患者护理的许多方面达成了共识。尽管如此，仍迫切需要更多证据来更好地为这一重症监护领域提供信息。
