重症监护病房中的非计划拔管：风险因素的证据。文献综述。
Unplanned Extubations in Intensive Care Unit: evidences for risk factors. A literature review.
作者信息
Cosentino Chiara, Fama Mattia, Foà Chiara, Bromuri Giorgia, Giannini Serena, Saraceno Marco, Spagnoletta Angela, Tenkue Mbemo, Trevisi Elena, Sarli Leopoldo
机构信息
Department of Medicine and Surgery, University of Parma.
出版信息
Acta Biomed. 2017 Nov 30;88(5S):55-65. doi: 10.23750/abm.v88i5-S.6869.
BACKGROUND AND AIM
Unplanned extubations (UE) are getting more and more relevant in Critical Care, becoming a quality and care safeness outcome. This happens because after an UE the patient can face some complications concerning the airway management, respiratory and hemodynamic problems, lengthen in the hospital stay and in the mechanical ventilation time. The aim of this review is identify and classify the factors that could increase UE risk.
METHODOLOGY
A systematic review of scientific articles was performed consulting the databases PubMed, Cinahl, Medline, EBSCOhost and Google Scholar. Articles from 2006 to 2011 were included. Pediatric Care settings were excluded.
RESULTS
21 articles were selected. From the results emerged that risk factors associated to the patient are widely controversial. Yet restlessness, a low level of sedation and a high level of consciousness seem to be highly related to UE. Organizational risk factors, as workload, nurse:patient ratio, and the use of interdisciplinary protocols seem to play an important role in UE.
CONCLUSION
According the current literature, the research on UE still has to handle a wide uncertainty. There is the need for more studies developing conclusive evidences on the role of different risk factors. Anyway, literature highlights the importance of the nurse and of the healthcare system organization in reducing UE incidence.
背景与目的
非计划拔管（UE）在重症监护中越来越受到关注，成为质量和护理安全的一项指标。出现这种情况是因为发生非计划拔管后，患者可能会面临一些与气道管理、呼吸和血流动力学问题相关的并发症，住院时间和机械通气时间延长。本综述的目的是识别并分类可能增加非计划拔管风险的因素。
方法
通过查阅PubMed、Cinahl、Medline、EBSCOhost和谷歌学术等数据库，对科学文献进行系统综述。纳入2006年至2011年的文章。排除儿科护理环境的文章。
结果
共筛选出21篇文章。结果显示，与患者相关的风险因素存在广泛争议。然而，烦躁不安、低镇静水平和高意识水平似乎与非计划拔管高度相关。组织风险因素，如工作量、护士与患者比例以及跨学科协议的使用，似乎在非计划拔管中起重要作用。
结论
根据当前文献，关于非计划拔管的研究仍存在很大不确定性。需要更多研究来提供关于不同风险因素作用的确凿证据。无论如何，文献强调了护士和医疗系统组织在降低非计划拔管发生率方面的重要性。
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