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关于机械通气循证实践的联合声明:来自两个巴西医学协会的建议

Joint statement on evidence-based practices in mechanical ventilation: suggestions from two Brazilian medical societies.

作者信息

Ferreira Juliana Carvalho, Vianna Arthur Oswaldo de Abreu, Pinheiro Bruno Valle, Maia Israel Silva, Baldisserotto Sérgio Vasconcellos, Isola Alexandre Marini

机构信息

. Division of Pulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.

. Clínica São Vicente, Rede D'Or São Luiz - Rio de Janeiro (RJ), Brazil.

出版信息

J Bras Pneumol. 2025 Feb 10;51(1):e20240255. doi: 10.36416/1806-3756/e20240255. eCollection 2025.

Abstract

Mechanical ventilation can be a life-saving intervention, but its implementation requires a multidisciplinary approach, with an understanding of its indications and contraindications due to the potential for complications. The management of mechanical ventilation should be part of the curricula during clinical training; however, trainees and practicing professionals frequently report low confidence in managing mechanical ventilation, often seeking additional sources of knowledge. Review articles, consensus statements and clinical practice guidelines have become important sources of guidance in mechanical ventilation, and although clinical practice guidelines offer rigorously developed recommendations, they take a long time to develop and can address only a limited number of clinical questions. The Associação de Medicina Intensiva Brasileira and the Sociedade Brasileira de Pneumologia e Tisiologia sponsored the development of a joint statement addressing all aspects of mechanical ventilation, which was divided into 38 topics. Seventy-five experts from all regions of Brazil worked in pairs to perform scoping reviews, searching for publications on their specific topic of mechanical ventilation in the last 20 years in the highest impact factor journals in the areas of intensive care, pulmonology, and anesthesiology. Each pair produced suggestions and considerations on their topics, which were presented to the entire group in a plenary session for modification when necessary and approval. The result was a comprehensive document encompassing all aspects of mechanical ventilation to provide guidance at the bedside. In this article, we report the methodology used to produce the document and highlight the most important suggestions and considerations of the document, which has been made available to the public in Portuguese.

摘要

机械通气可能是一种挽救生命的干预措施,但其实施需要多学科方法,鉴于可能出现的并发症,要了解其适应证和禁忌证。机械通气的管理应成为临床培训课程的一部分;然而,实习生和执业专业人员经常表示在管理机械通气方面信心不足,常常寻求额外的知识来源。综述文章、共识声明和临床实践指南已成为机械通气指导的重要来源,尽管临床实践指南提供了经过严格制定的建议,但制定时间长,且只能解决有限数量的临床问题。巴西重症医学协会和巴西肺病与胸科学会赞助制定了一份关于机械通气各方面的联合声明,该声明分为38个主题。来自巴西所有地区的75位专家两两合作进行范围审查,在过去20年里在重症监护、肺病学和麻醉学领域影响因子最高的期刊上搜索关于其特定机械通气主题的出版物。每一对专家就其主题提出建议和考量,在全体会议上提交给整个小组,必要时进行修改并获得批准。结果是形成了一份涵盖机械通气各方面的综合文件,以便在床边提供指导。在本文中,我们报告了用于生成该文件的方法,并突出了该文件最重要的建议和考量,该文件已以葡萄牙语向公众提供。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/35f5/11796564/cbd1800d58fc/1806-3756-jbpneu-51-01-e20240255-gf1.jpg

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