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重新审视儿科重症监护病房的非计划性拔管:有哪些新情况?

Revisiting unplanned extubation in the pediatric intensive care unit: What's new?

作者信息

da Silva Paulo Sérgio Lucas, Farah Daniela, Fonseca Marcelo Cunio Machado

机构信息

Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, R. Castro Alves 60, São Paulo, 01532-000, Brazil.

Health Technology Assessment Unit, Federal University of São Paulo (UNIFESP), R Botucatu, n° 740, São Paulo, 04023-062, Brazil.

出版信息

Heart Lung. 2017 Nov-Dec;46(6):444-451. doi: 10.1016/j.hrtlng.2017.08.006. Epub 2017 Sep 12.

Abstract

In 2010, recommendations for preventing unplanned extubations (UEs) in pediatric patients were published based on a literature review. Since then, there have been an increasing number of publications related to UE focusing on children. If the introduction of care bundles and larger body of evidence on UE had impact on UE occurrence, this would have important implications on clinical practice. We searched for relevant publications published between Jan 1, 2010 and Jun 30, 2016 in the MEDLINE, EMBASE, and Cochrane systems. Eight articles were eligible for data abstraction. Three studies were of high methodological quality. The mean contemporaneous incidence of UEs was 1.19 UEs/100 intubation days. The primary risk factors were as follows: caregiver bedside procedures/manipulation, agitation, and endotracheal tube care. The ideal incidence of UEs remains unknown. Key areas identified in the current review may be amenable to changes in unit processes by implementing a care bundle strategy.

摘要

2010年,基于文献综述发布了预防儿科患者非计划性拔管(UE)的建议。自那时以来,越来越多关于UE的出版物聚焦于儿童。如果引入护理束以及更多关于UE的证据对UE发生率产生影响,这将对临床实践产生重要影响。我们在MEDLINE、EMBASE和Cochrane系统中检索了2010年1月1日至2016年6月30日期间发表的相关出版物。八篇文章符合数据提取条件。三项研究具有较高的方法学质量。UE的同期平均发生率为1.19次/100气管插管日。主要危险因素如下:护理人员床边操作、躁动和气管插管护理。UE的理想发生率仍然未知。当前综述中确定的关键领域可能通过实施护理束策略来改变科室流程。

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