Durbin C G
Department of Anesthesiology, University of Virginia Health Sciences Center, Charlottesville, USA.
Respir Care Clin N Am. 1996 Mar;2(1):105-16.
TDPs occasionally are used to standardize or control respiratory management of the critically ill. Weaning protocols are most common. Little objective evaluation of the effects of TDPs in the critically ill has been published. Most protocols have been developed to improve efficiency of respiratory care staff and reduce unnecessary treatments in non-ICU patients. The most important reason for using TDPs in the ICU is to improve consistency of care. Reduction of variation between individual therapist style improves physicians' trust in the respiratory care department. Improved consistency may allow novel ICU therapies to be evaluated objectively. In general, TDPs are not directly transportable from one area or institution to another. TDPs require local development, and all interested parties must be part of the development process for success. The process of creating TDPs provides a forum for physicians, nurses, and therapists to establish mutual respect and understanding. The analytic approach needed to create useful TDPs provides a critical evaluation of unit procedures and promotes changes in care delivery extending outside the TDP. The complexity of disease process and patient care in the ICU makes comprehensive TDPs difficult to establish; however, use of computers for decision support can overcome the limitations of paper flow charts. Even without comprehensive TDPs, the development process is important to improving and understanding care of the critically ill. The effects of TDPs on ICU patient outcome are unknown currently. Benefits are possible and improved collaboration, better respiratory care staff morale, consistency of approach to care, and critical approach to clinical decision making can be gained by attempting to develop TDPs for respiratory care delivery in the ICU.
治疗决策方案（TDPs）偶尔用于规范或控制重症患者的呼吸管理。撤机方案最为常见。关于TDPs对重症患者影响的客观评估报道较少。大多数方案是为提高呼吸护理人员的效率和减少非重症监护病房（ICU）患者的不必要治疗而制定的。在ICU中使用TDPs的最重要原因是提高护理的一致性。减少个体治疗师风格之间的差异可提高医生对呼吸护理部门的信任。提高一致性可能有助于客观评估新的ICU治疗方法。一般来说，TDPs不能直接从一个地区或机构移植到另一个地区或机构。TDPs需要因地制宜制定，所有相关方都必须参与制定过程才能取得成功。创建TDPs的过程为医生、护士和治疗师提供了一个相互尊重和理解的平台。创建有用的TDPs所需的分析方法可对科室程序进行严格评估，并促进护理方式在TDP之外的改变。ICU中疾病过程和患者护理的复杂性使得难以制定全面的TDPs；然而，使用计算机进行决策支持可以克服纸质流程图的局限性。即使没有全面的TDPs，制定过程对于改善和理解重症患者的护理也很重要。目前尚不清楚TDPs对ICU患者预后的影响。通过尝试为ICU的呼吸护理制定TDPs，可能会带来益处，如改善协作、提高呼吸护理人员的士气、护理方法的一致性以及临床决策的严谨性。
