Giovanni Shewit P, Jennerich Ann L, Steel Tessa L, Lokhandwala Sharukh, Alhazzani Waleed, Weiss Curtis H, Hough Catherine L
Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, OR.
Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA.
Crit Care Explor. 2021 Apr 26;3(4):e0391. doi: 10.1097/CCE.0000000000000391. eCollection 2021 Apr.
Low tidal volume ventilation and prone positioning are recommended therapies yet underused in acute respiratory distress syndrome. We aimed to assess the role of interventions focused on implementation of low tidal volume ventilation and prone positioning in mechanically ventilated adult patients with acute respiratory distress syndrome.
PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials.
We searched the four databases from January 1, 2001, to January 28, 2021, for studies that met the predefined search criteria. Selected studies focused on interventions to improve implementation of low tidal volume ventilation and prone positioning in mechanically ventilated patients with acute respiratory distress syndrome.
Two authors independently performed study selection and data extraction using a standardized form.
Due to methodological heterogeneity of included studies, meta-analysis was not feasible; thus, we provided a narrative summary and assessment of the literature. Eight nonrandomized studies met our eligibility criteria. Most studies looked at interventions to improve adherence to low tidal volume ventilation. Most interventions focused on education for providers. Studies were primarily conducted in the ICU and involved trainees, intensivists, respiratory therapists, and critical care nurses. Although overall quality of the studies was very low, the primary outcomes of interest suggest that interventions could improve adherence to or implementation of low tidal volume ventilation and prone positioning in acute respiratory distress syndrome.
Two authors independently performed study selection and data extraction using a standardized form. Due to methodologic heterogeneity of included studies, meta-analysis was not feasible; thus, we provided a narrative summary and assessment of the literature. Eight nonrandomized studies met our eligibility criteria. Most studies looked at interventions to improve adherence to low tidal volume ventilation. Most interventions focused on education for providers. Studies were primarily conducted in the ICU and involved trainees, intensivists, respiratory therapists, and critical care nurses. Although overall quality of the studies was very low, the primary outcomes of interest suggest that interventions could improve adherence to or implementation of low tidal volume ventilation and prone positioning in acute respiratory distress syndrome.
There is a dearth of literature addressing interventions to improve implementation of evidence-based practices in acute respiratory distress syndrome. Existing interventions to improve clinician knowledge and facilitate application of low tidal volume ventilation and prone positioning may be effective, but supporting studies have significant limitations.
低潮气量通气和俯卧位通气是推荐的治疗方法，但在急性呼吸窘迫综合征中未得到充分应用。我们旨在评估针对机械通气的成年急性呼吸窘迫综合征患者实施低潮气量通气和俯卧位通气的干预措施的作用。
PubMed、医学文摘数据库、护理学与健康相关文献累积索引以及Cochrane对照试验中心注册库。
我们检索了这四个数据库，时间跨度为2001年1月1日至2021年1月28日，以查找符合预定义检索标准的研究。选定的研究聚焦于改善机械通气的急性呼吸窘迫综合征患者低潮气量通气和俯卧位通气实施情况的干预措施。
两位作者使用标准化表格独立进行研究选择和数据提取。
由于纳入研究的方法学异质性，荟萃分析不可行；因此，我们提供了文献的叙述性总结和评估。八项非随机研究符合我们的纳入标准。大多数研究着眼于改善低潮气量通气依从性的干预措施。大多数干预措施侧重于对医护人员的教育。研究主要在重症监护病房进行，涉及实习生、重症医学专家、呼吸治疗师和重症护理护士。尽管研究的总体质量很低，但感兴趣的主要结果表明，干预措施可能会提高急性呼吸窘迫综合征患者对低潮气量通气和俯卧位通气的依从性或实施情况。
两位作者使用标准化表格独立进行研究选择和数据提取。由于纳入研究的方法学异质性，荟萃分析不可行；因此，我们提供了文献的叙述性总结和评估。八项非随机研究符合我们的纳入标准。大多数研究着眼于改善低潮气量通气依从性的干预措施。大多数干预措施侧重于对医护人员的教育。研究主要在重症监护病房进行，涉及实习生、重症医学专家、呼吸治疗师和重症护理护士。尽管研究的总体质量很低，但感兴趣的主要结果表明，干预措施可能会提高急性呼吸窘迫综合征患者对低潮气量通气和俯卧位通气的依从性或实施情况。
缺乏关于改善急性呼吸窘迫综合征循证实践实施情况的干预措施的文献。现有的改善临床医生知识并促进低潮气量通气和俯卧位通气应用的干预措施可能有效，但支持性研究存在重大局限性。
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