■从机械呼吸机撤机是重症监护患者康复的里程碑。断奶和重新插管失败会对结果产生不利影响。机械通气(MV)的方法在不同的ICU之间有所不同,断奶的做法也是如此。因此,基于当代文学的最新指南旨在指导现代ICU的强化专家。这是由断奶委员会编写的关于断奶的第一个ISCM共识声明。这些建议旨在供ICU的所有成员使用(Intervisists,注册商,护士,和呼吸治疗师)。
■从MV断奶委员会,由印度重症监护医学学会(ISCM)成立,在对文献进行回顾后,就重症监护病房(ICU)机械呼吸机的断奶提出了这一声明。文献首先在专家委员会成员中分发,并为每个成员分配了部分。部分作者撰写的声明的部分通过虚拟会议多次进行了同行评审。在最终手稿被所有委员会成员接受后,它由ISCM中央指南委员会提交同行评审。一旦获得批准,它已通过IJCCM编辑委员会的审查,然后在此处作为“ISCM关于机械呼吸机断奶的共识声明”发布。根据ISCM所有准则所接受的标准,我们遵循了建议评估的修改等级,开发和评估(GRADE)系统,对证据质量和推荐强度进行分类。成本效益,风险效益分析,委员会考虑了在印度ICU实施的可行性以及证据的强度。呼吸机的类型及其模式,ICU人员配备模式,重症监护护士的可用性,呼吸治疗师,白天和夜间人员配置是在建议或反对断奶的任何方面时考虑的方面。
■本文件就断奶的各个方面提出建议,即,定义,定时,断奶标准,断奶方法,断奶失败的诊断,定义难以断奶,使用NIV,HFOV作为断奶的辅助,气管造口术在断奶中的作用,长期通气患者的断奶,理疗的作用,动员断奶,营养在断奶中的作用,膈肌超声在断奶预测等方面的作用.在42个问题中;委员会提供了39项建议,但没有提出3个问题。在这39个中;32个基于证据,7个基于委员会成员的专家意见。它提供了27项强有力的建议和12项薄弱的建议(建议)。
■本指南对机械呼吸机的断奶进行了广泛的审查,并提供了有关机械呼吸机断奶的各种建议。尽管所有努力都尽可能地更新,但仍需要定期审查任何准则,以使其与即将到来的概念和标准保持一致。
■职员AM,ShahRJ,KothariJ,SodhiK,瓦迪S,巴塔查里亚PK,etal.ISCM委员会关于机械呼吸机断奶的立场声明。印度J暴击护理中心2024;28(S2):S233-S248。
UNASSIGNED: Weaning from a mechanical ventilator is a milestone in the recovery of seriously ill patients in Intensive care. Failure to wean and re-intubation adversely affects the outcome. The method of mechanical ventilation (MV) varies between different ICUs and so does the practice of weaning. Therefore, updated guidelines based on contemporary literature are designed to guide intensivists in modern ICUs. This is the first ISCCM Consensus Statement on weaning complied by a committee on weaning. The recommendations are intended to be used by all the members of the ICU (Intensivists, Registrars, Nurses, and Respiratory Therapists).
UNASSIGNED: A Committee on weaning from MV, formed by the Indian Society of Critical Care Medicine (ISCCM) has formulated this statement on weaning from mechanical ventilators in intensive care units (ICUs) after a review of the literature. Literature was first circulated among expert committee members and allotted sections to each member. Sections of the statement written by sectional authors were peer-reviewed on multiple occasions through virtual meetings. After the final manuscript is accepted by all the committee members, it is submitted for peer review by central guideline committee of ISCCM. Once approved it has passed through review by the Editorial Board of IJCCM before it is published here as \"ISCCM consensus statement on weaning from mechanical ventilator\". As per the standard accepted for all its guidelines of ISCCM, we followed the modified grading of recommendations assessment, development and evaluation (GRADE) system to classify the quality of evidence and strength of recommendation. Cost-benefit, risk-benefit analysis, and feasibility of implementation in Indian ICUs are considered by the committee along with the strength of evidence. Type of ventilators and their modes, ICU staffing pattern, availability of critical care nurses, Respiratory therapists, and day vs night time staffing are aspects considered while recommending for or against any aspect of weaning.
UNASSIGNED: This document makes recommendation on various aspects of weaning, namely, definition, timing, weaning criteria, method of weaning, diagnosis of failure to wean, defining difficult to wean, Use of NIV, HFOV as adjunct to weaning, role of tracheostomy in weaning, weaning in of long term ventilated patients, role of physiotherapy, mobilization in weaning, Role of nutrition in weaning, role of diaphragmatic ultrasound in weaning prediction etc. Out of 42 questions addressed; the committee provided 39 recommendations and refrained from 3 questions. Of these 39; 32 are based on evidence and 7 are based on expert opinion of the committee members. It provides 27 strong recommendations and 12 weak recommendations (suggestions).
UNASSIGNED: This guideline gives extensive review on weaning from mechanical ventilator and provides various recommendations on weaning from mechanical ventilator. Though all efforts are made to make is as updated as possible one needs to review any guideline periodically to keep it in line with upcoming concepts and standards.
UNASSIGNED: Clerk AM, Shah RJ, Kothari J, Sodhi K, Vadi S, Bhattacharya PK, et al. Position Statement of ISCCM Committee on Weaning from Mechanical Ventilator. Indian J Crit Care Med 2024;28(S2):S233-S248.