报告关于神经重症监护患者液体治疗的ESICM共识和临床实践建议。
由22名国际专家组成的共识委员会于2016年10月在ESICMLIVES2016期间举行了会议。委员会成员之间的电话会议和基于电子的讨论随后有助于讨论和发展共识进程。
人口,干预,比较,并根据需要审查和更新结果(PICO)问题,和生成的证据资料。共识集中在三个主要议题上:(1)神经重症监护病人的一般液体复苏和维持,(2)高渗液用于颅内压控制,(3)蛛网膜下腔出血后迟发性脑缺血的液体管理。经过广泛的文献检索,建议评估分级的原则,开发和评估(GRADE)系统用于评估证据的质量(从高到非常低),制定强或弱的治疗建议,并在适用时发布最佳实践声明。一种基于文献和专家意见提供的证据整合的改进的Delphi过程-使用顺序方法避免偏见和误解-用于生成最终共识声明。
最终共识包括总共32项声明,包括13项强有力的建议和17项薄弱的建议。没有就两项声明提出建议。
我们提出了关于神经重症监护患者液体治疗的共识声明和临床实践建议。
To report the ESICM
consensus and clinical practice recommendations on fluid therapy in neurointensive care patients.
A
consensus committee comprising 22 international experts met in October 2016 during ESICM LIVES2016. Teleconferences and electronic-based discussions between the members of the committee subsequently served to discuss and develop the consensus process.
Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles generated. The
consensus focused on three main topics: (1) general fluid resuscitation and maintenance in neurointensive care patients, (2) hyperosmolar fluids for intracranial pressure control, (3) fluid management in delayed cerebral ischemia after subarachnoid haemorrhage. After an extensive literature search, the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were applied to assess the quality of evidence (from high to very low), to formulate treatment recommendations as strong or weak, and to issue best practice statements when applicable. A modified Delphi process based on the integration of evidence provided by the literature and expert opinions-using a sequential approach to avoid biases and misinterpretations-was used to generate the final consensus statement.
The final
consensus comprises a total of 32 statements, including 13 strong recommendations and 17 weak recommendations. No recommendations were provided for two statements.
We present a
consensus statement and clinical practice recommendations on fluid therapy for neurointensive care patients.