与需要持续通气支持的个体相关的患者转诊：一项德尔菲研究。
Patient transitions relevant to individuals requiring ongoing ventilatory assistance: a Delphi study.
作者信息
Rose Louise, Fowler Robert A, Goldstein Roger, Katz Sherri, Leasa David, Pedersen Cheryl, McKim Douglas
出版信息
Can Respir J. 2014 Sep-Oct;21(5):287-92. doi: 10.1155/2014/484835. Epub 2014 May 2.
BACKGROUND
Various terms, including 'prolonged mechanical ventilation' (PMV) and 'long-term mechanical ventilation' (LTMV), are used interchangeably to distinguish patient cohorts requiring ventilation, making comparisons and timing of clinical decision making problematic.
OBJECTIVE
To develop expert, consensus-based criteria associated with care transitions to distinguish cohorts of ventilated patients.
METHODS
A four-round (R), web-based Delphi study with consensus defined as >70% was performed. In R1, participants listed, using free text, criteria perceived to should and should not define seven transitions. Transitions comprised: T1 - acute ventilation to PMV; T2 - PMV to LTMV; T3 - PMV or LTMV to acute ventilation (reverse transition); T4 - institutional to community care; T5 - no ventilation to requiring LTMV; T6 - pediatric to adult LTMV; and T7 - active treatment to end-of-life care. Subsequent Rs sought consensus.
RESULTS
Experts from intensive care (n=14), long-term care (n=14) and home ventilation (n=10), representing a variety of professional groups and geographical areas, completed all Rs. Consensus was reached on 14 of 20 statements defining T1 and 21 of 25 for T2. 'Physiological stability' had the highest consensus (97% and 100%, respectively). 'Duration of ventilation' did not achieve consensus. Consensus was achieved on 13 of 18 statements for T3 and 23 of 25 statements for T4. T4 statements reaching 100% consensus included: 'informed choice', 'patient stability', 'informal caregiver support', 'caregiver knowledge', 'environment modification', 'supportive network' and 'access to interprofessional care'. Consensus was achieved for 15 of 17 T5, 16 of 20 T6 and 21 of 24 T7 items.
CONCLUSION
Criteria to consider during key care transitions for ventilator-assisted individuals were identified. Such information will assist in furthering the consistency of clinical care plans, research trials and health care resource allocation.
背景
包括“延长机械通气”（PMV）和“长期机械通气”（LTMV）在内的各种术语被交替使用，以区分需要通气的患者队列，这使得临床决策的比较和时机选择存在问题。
目的
制定基于专家共识的与护理过渡相关的标准，以区分通气患者队列。
方法
进行了一项基于网络的四轮德尔菲研究，将共识定义为超过70%。在第一轮中，参与者使用自由文本列出他们认为应该和不应该定义七种过渡的标准。过渡包括：T1——急性通气到PMV；T2——PMV到LTMV；T3——PMV或LTMV到急性通气（反向过渡）；T4——机构护理到社区护理；T5——无创通气到需要LTMV；T6——儿科到成人LTMV；以及T7——积极治疗到临终关怀。后续轮次寻求达成共识。
结果
来自重症监护（n = 14）、长期护理（n = 14）和家庭通气（n = 10）的专家，代表了各种专业团体和地理区域，完成了所有轮次。在定义T1的20条陈述中有14条以及定义T2的25条陈述中有21条达成了共识。“生理稳定性”的共识度最高（分别为97%和100%）。“通气持续时间”未达成共识。在定义T3的18条陈述中有13条以及定义T4的25条陈述中有23条达成了共识。T4中达成100%共识的陈述包括：“知情选择”“患者稳定性”“非正式护理人员支持”“护理人员知识”“环境改造”“支持网络”和“获得跨专业护理”。在T5的17项中有15项、T6的20项中有16项以及T7的24项中有21项达成了共识。
结论
确定了在呼吸机辅助个体的关键护理过渡期间应考虑的标准。此类信息将有助于提高临床护理计划、研究试验和医疗资源分配的一致性。
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