成人机械通气患者的管理：一项全英国范围的调查。
Management of adult mechanically ventilated patients: A UK-wide survey.
作者信息
Ward James, Terrington Isis, Preston Katie, Smith Alexander, Roe Thomas, Barnes Jonathan, Allen Emma, Lima Sandra, Cusack Rebecca, Grocott Michael P W, Dushianthan Ahilanandan
机构信息
General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Perioperative and Critical Care Theme, Southampton National Institute of Health Research Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK.
出版信息
J Intensive Care Soc. 2024 Oct 20;26(2):127-136. doi: 10.1177/17511437241292190. eCollection 2025 May.
BACKGROUND
Mechanical ventilation is a common and often lifesaving intervention that is utilised in intensive care. However, the practices can vary between centres. Through this national survey we aim to gain more information about different strategies adopted across the UK.
METHODS
All adult intensive care units in the UK were approached to participate. The questionnaire was developed with an electronic survey engine and conducted between 09/11/2023 and 01/04/2024 (Survey Monkey). The survey included questions on ventilator modes, settings, protocols/pathways, rescue strategies, immediate post-extubation period and follow-up.
RESULTS
There were 196 responses from 104 hospitals. The most widely adopted start-up ventilation mode was pressure-regulated volume-controlled mode. For acute hypoxaemic respiratory failure (AHRF), most of respondents reported full (39.8%) or partial compliance (58.1%) with the ARDSnet protocol, with PEEP settings being the commonest deviation. Prone positioning (99.0%), followed by recruitment manoeuvres (91.3%) were commonly used rescue measures during AHRF. APRV (55.7%), inhaled (51.3%) and systemic pulmonary vasodilators (44.1%) were also commonly used. Conservative oxygen targets (SaO of 88%-92%) were commonly adopted (70.6%). As a care bundle, intermittent ETT cuff pressure monitoring was more common (65.5%) than continuous cuff pressure monitoring (20.0%). Propofol and alfentanil were the most common initial sedative and analgesia (99.5% and 56.9%) respectively. Routine volatile anaesthetic use was rare.
CONCLUSIONS
Our survey has shown significant variation of practice in common but crucial elements of management of patients receiving mechanical ventilation. We hope the results in our survey highlight potential future areas of research.
COLLABORATORS
South-coast Peri-operative Audit and Research Collaborative (SPARC)Severn Trainee Anaesthetic and Critical Care Research group (STAR)Collaborative research in Anaesthesia in the Northeast (CRANE).
背景
机械通气是重症监护中常用且常常能挽救生命的干预措施。然而，不同中心的操作方法可能存在差异。通过这项全国性调查，我们旨在获取更多关于英国各地采用的不同策略的信息。
方法
我们联系了英国所有的成人重症监护病房参与调查。问卷通过电子调查引擎编制，并于2023年11月9日至2024年4月1日期间进行（使用Survey Monkey）。调查内容包括呼吸机模式、设置、方案/路径、抢救策略、拔管后即刻阶段及随访等问题。
结果
来自104家医院的196份问卷得到回复。最广泛采用的初始通气模式是压力调节容量控制模式。对于急性低氧性呼吸衰竭（AHRF），大多数受访者报告完全（39.8%）或部分（58.1%）遵循ARDSnet方案，其中呼气末正压（PEEP）设置是最常见的偏差。俯卧位通气（99.0%），其次是肺复张手法（91.3%）是AHRF期间常用的抢救措施。气道压力释放通气（APRV，55.7%）、吸入性（51.3%）和全身性肺血管扩张剂（44.1%）也常用。保守的氧目标（动脉血氧饱和度为88% - 92%）普遍采用（70.6%）。作为护理集束，间歇性气管插管套囊压力监测比持续性套囊压力监测更常见（65.5%对20.0%）。丙泊酚和阿芬太尼分别是最常用的初始镇静剂和镇痛药（99.5%和56.9%）。常规使用挥发性麻醉剂很少见。
结论
我们的调查显示，在接受机械通气患者管理的常见但关键要素方面，操作存在显著差异。我们希望我们的调查结果突出未来潜在的研究领域。
合作者
南海岸围手术期审计与研究协作组（SPARC）；塞文地区麻醉与重症监护实习研究组（STAR）；东北地区麻醉协作研究组（CRANE）
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