Nydahl P, Hermes C, Dubb R, Kaltwasser A, Schuchhardt D
Pflegeforschung, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Haus 31, Brunswiker Str. 10, 24105, Kiel, Deutschland,
Med Klin Intensivmed Notfmed. 2015 Feb;110(1):68-76. doi: 10.1007/s00063-014-0449-x. Epub 2014 Dec 21.
Modern concepts for sedation and analgesia and guidelines recommend light analgesia and sedation, so that patients on mechanically ventilation are more awake, compared to previous concepts. Hence, these patients are more alert and able to experience their situation on the ventilator and their endotracheal tube (ETT).
There is currently no convincing evidence of how patients tolerate the tube under present conditions, which interventions could help them, or whether they want to be sedated deeper because of the tube. Based upon our own observations, a broad range of reactions are possible.
The tolerance of the ETT in intensive care patients was explored.
A systematic literature research without time constraints in the databases PubMed and CINAHL was performed. Included were quantitative and qualitative studies written in German or English that investigated tolerance of the ETT in adult intensive care patients. Excluded were anesthetic studies including in- and extubation immediately before and after operations.
Of the 2348 hits, 14 studies were included, including 4 qualitative studies about the experience of intensive care, 8 quantitative studies including 2 randomized controlled studies, and 2 studies with a mixed approach. Within the studies different aspects could be identified, which may in- or decrease the tolerance of an ETT. Aspects like breathlessness, pain during endotracheal suctioning and inability to speak decrease the tolerance. Information, the presence of relatives and early mobilization appear to increase the tolerance.
Tolerance of the ETT is a complex phenomenon. A reflected and critical evaluation of the behavior of the patient with an ETT is recommended. Interventions that increase the tolerance of the ETT should be adapted to the situation of the patient and should be evaluated daily.
现代镇静镇痛理念及指南推荐采用轻度镇痛和镇静，与以往理念相比，接受机械通气的患者能更加清醒。因此，这些患者更加警觉，能够感知自己在呼吸机及气管内插管（ETT）状态下的情况。
目前尚无令人信服的证据表明患者在当前情况下如何耐受气管插管，哪些干预措施可帮助他们，或者他们是否因气管插管而希望加深镇静。基于我们自己的观察，可能会出现广泛的反应。
探讨重症监护患者对气管内插管的耐受性。
在PubMed和CINAHL数据库中进行了无时间限制的系统文献研究。纳入的是用德语或英语撰写的定量和定性研究，这些研究调查了成年重症监护患者对气管内插管的耐受性。排除的是包括手术前后即刻插管和拔管的麻醉研究。
在检索到的2348篇文献中，纳入了14项研究，包括4项关于重症监护体验的定性研究、8项定量研究（包括2项随机对照研究）以及2项混合方法研究。在这些研究中，可以确定不同的方面，这些方面可能会增加或降低对气管内插管的耐受性。诸如呼吸困难、气管内吸痰时的疼痛以及无法说话等方面会降低耐受性。信息、亲属陪伴和早期活动似乎会增加耐受性。
对气管内插管的耐受性是一个复杂的现象。建议对气管内插管患者的行为进行深思熟虑和批判性的评估。提高对气管内插管耐受性的干预措施应根据患者的情况进行调整，并应每日进行评估。
