重症监护学科最近的范式转变导致了协议的实施,以推动重症监护病房(ICU)的早期恢复。这些协议属于大量知识,由重症监护医学学会领导的翻译和质量改进计划,旨在将患者从ICU中“解放”。他们“捆绑”以证据为基础的元素显示出降低ICU住院时间和死亡率并优化疼痛管理。捆绑的元素侧重于评估,预防和管理疼痛;自主觉醒试验和自主呼吸试验;镇痛和镇静的选择;评估,预防,和谵妄的管理;早期流动性和锻炼;以及家庭参与和赋权(ABCDEF)。显然,镇痛和镇静方案直接涉及或影响大多数束元件。神经损伤患者的文献很少,他们为捆绑实施创造了独特的挑战,并且在现有的研究中往往具有有限的外部有效性。我们将系统地搜索文献,呈现神经重症监护患者的独特挑战,对感兴趣的子群进行分层分析,并在神经重症监护病房(NICU)传播镇痛和镇静方案的证据。我们希望相关利益相关者可以通过知识翻译来调整这些信息-在临床实践指南或立场声明中提出正式建议。
作者将搜索MEDLINE(PubMed),EMBASE,科克伦图书馆,Cochrane临床试验注册,世界卫生组织国际临床试验注册平台搜索门户,和美国国立卫生研究院临床试验注册。标题,abstract,全文筛选将一式两份完成,并将报告科恩的卡帕系数。如果从研究中检索到的数据是合适的,结果将使用荟萃分析进行统计学组合。我们旨在评估ABCDEF捆绑组件对NICU恢复的多个终点的影响。我们的主要结果将是成功停止机械通气的时间和早期活动的时间。作者将使用PRISMA声明指导研究的方法学设计,并提供清单合规性。
利用本系统评价的证据,我们期望在NICU中传播镇痛和镇静方案的知识。这项系统评价的结果对于缩小通常被排除在研究之外的患者群体的知识差距至关重要。并增加旨在促进NICU早期康复和减轻医源性伤害的文献。
PROSPEROCRD42017078909。
A recent paradigm shift within the intensive care discipline has led to implementation of protocols to drive early recovery from the intensive care unit (ICU). These protocols belong to a large knowledge, translation and quality improvement initiative lead by the Society of Critical Care Medicine, aiming to \"liberate\" patients from the ICU. They \"bundle\" evidence-based elements shown to lower ICU stay and mortality and optimize pain management. The bundled elements focus on Assessing, preventing and managing pain; Both spontaneous awakening trials and spontaneous breathing trials; Choice of analgesia and sedation; assessment, prevention, and management of Delirium; Early mobility and exercise; and Family engagement and empowerment (ABCDEF). It is evident that analgesia and sedation protocols either directly relate to or influence most of the bundle elements. A paucity of literature exists for neurologically injured patients, who create unique challenges to bundle implementation and often have limited external validity in existent studies. We will systematically search the literature, present the unique challenges of neurointensive care patients, conduct a stratified analysis of subgroups of interest, and disseminate the evidence of analgesia and sedation protocols in the neurointensive care unit (NICU). We hope the relevant stakeholders can adapt this information through knowledge translation-to make formal recommendations in clinical practice guidelines or a position statement.
The authors will search MEDLINE (PubMed), EMBASE, Cochrane Library, Cochrane Clinical Trials Registry, World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. The title, abstract, and full-text screening will be completed in duplicate, and a Cohen\'s Kappa coefficient of agreement will be reported. Provided the data retrieved from studies is suitable, results will be combined statistically using meta-analysis. We aim to evaluate the impact of ABCDEF bundle components on multiple endpoints of NICU recovery. Our primary outcomes will be time to successful discontinuation of mechanical ventilation and time to early mobility. The authors will guide the methodological design of the study using the PRISMA-statement and the checklist compliance will be available.
Using the evidence from this systematic
review, we anticipate disseminating knowledge of analgesia and sedation protocols in the NICU. The results of this systematic
review are imperative to close the knowledge gap in a patient population that is often excluded from studies, and to add to the body of literature aiming to enhance early recovery from the NICU and mitigate iatrogenic harm.
PROSPERO CRD42017078909.