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Journal of Nursing ›› 2021, Vol. 28 ›› Issue (6): 27-32.doi: 10.16460/j.issn1008-9969.2021.06.027

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Best Evidence Summary for Weaning from Mechanical Ventilation of Adult Patients in Intensive Care Unit

CUI Zhao-meia, LIU Jinga, ZHUANG Xina, DU Juana, DONG Chun-huib   

  1. a. Dept. of Cardiac Surgery ICU; b. Dept. of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250014, China
  • Received:2020-11-06 Online:2021-03-25 Published:2021-04-08

Abstract: Objective To evaluate and summarize the best evidence for weaning from mechanical ventilation of adult patients in intensive care unit. Methods Evidence-based problems were determined based on the PIPOST pattern then we electronically retrieved the research on the weaning from mechanical ventilation. Reviewers independently assessed the quality and extracted the data in the included studies. Evidence was summarized from eligible studies. Results Twelve articles were included, with 3 clinical decisions, 4 guidelines, 2 best evidence summary and 3 systematic reviews. Evidence was extracted and summarized into 25 items, which were classified into 4 categories including: assessment of weaning screening, weaning protocol implementing, tracheal tube extraction and organizational administration. Conclusion Weaning from mechanical ventilation of adult patients in intensive care unit is a dynamic and complicated process. A practical weaning program, and standardized training for medical staff on weaning knowledge, program and procedure are conducive to the success of weaning thus to improve clinical outcome.

Key words: weaning, mechanical ventilation, ICU, adult, evidence summary

CLC Number: 

  • R473.6
[1] Jordan J, Rose L, Dainty KN, et al.Factors that Impact on the Use of Mechanical Ventilation Weaning Protocols in Critically Ill Adults and Children: A Qualitative Evidence-synthesis[J].Cochrane Database Syst Rev, 2016, 10(10): CD011812. DOI:10.1002/14651858.CD011812.pub2.
[2] Thille AW, Cortés-Puch I, Esteban A.Weaning from the Ventilator and Extubation in ICU[J].Curr Opin Crit Care,2013, 19(1):57-64. DOI:10.1097/MCC.0b013e32835c5095.
[3] Lin F, Kuo Y, Jerng J, et al.Association of Weaning Preparedness with Extubation Outcome of Mechanically Ventilated Patients in Medical Intensive Care Units:A Retrospective Analysis[J].Peer J,2020(8):e8973. DOI:10.7717/peerj.8973.
[4] Pu L, Zhu B, Jiang L, et al.Weaning Critically Ill Patients from Mechanical Ventilation: A Prospective Cohort Study[J].J Crit Care,2015, 30(4):862.e7-862.e13. DOI:10.1016/j.jcrc.2015.04.001.
[5] MacIntyre NR, Cook DJ, Ely EJ, et al.Evidence-based Guidelines for Weaning and Discontinuing Ventilatory Support: A Collective Task Force Facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine[J].Chest, 2001, 120(6 Suppl):375-395. DOI:10.1378/chest.120.6_suppl.375s.
[6] Girard TD, Alhazzani W,Kress JP,et al.An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline:Liberation from Mechanical Ventilation in Critically Ill Adults.Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests[J].Am J Respir Crit Care Med, 2017, 195(1):120-133. DOI:10.1016/j.chest.2016.10.037.
[7] Ouellette DR, Patel S, Girard TD, et al.Liberation from Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline:Inspiratory Pressure Augmentation During Spontaneous Breathing Trials, Protocols Minimizing Sedation, and Noninvasive Ventilation Immediately after Extubation[J].Chest, 2017, 151(1):166-180. DOI:10.1016/j.chest.2016.10.036.
[8] 中华医学会重症医学分会.机械通气临床应用指南(2006)[J].中国危重病急救医学, 2007,19(2):65-72. DOI:10.3760/j.issn:1003-0603.2007.02.002.
[9] 樊麦英,罗杰英,文辉,等.超声监测膈肌运动指标对机械通气撤机的指导价值[J].中华危重病急救医学, 2018, 30(11):1041-1045. DOI:10.3760/cma.j.issn.2095-4352.2018.11.006.
[10] 刘芙香,郭凤梅.电阻抗成像指导机械通气患者撤机的研究进展[J].中华危重病急救医学, 2019, 31(2):241-243. DOI:10.3760/cma.j.issn.2095-4352.2019.02.025.
[11] 王新存,葛保国,刘亚敏,等.程序化撤机对机械通气重症脑卒中患者撤机成功率和并发症的影响[J].中国实用神经疾病杂志, 2019, 22(18):2049-2055. DOI:10.12083/SYSJ.2019.18.341.
[12] Hirzallah FM, Alkaissi A, Do Céu Barbieri Figueiredo M.A Systematic Review of Nurse-led Weaning Protocol for Mechanically Ventilated Adult Patients[J].Nurs Crit Care, 2019, 24(2):89-96. DOI:10.1111/nicc.12404.
[13] 胡雁,郝玉芳.循证护理学[M].北京:人民卫生出版社, 2018.
[14] Dicenso A, Bayley L, Haynes RB, et al.Accessing Preappraised Evidence: Finetuning the 5S Model Into A 6S Model[J].Evid Based Nurs,2009,12(4):99. DOI:10.1136/ebn.12.4.99-b.
[15] Brouwers MC, Kho ME, Browman GP, et al.AGREE II: Advancing Guideline Development, Reporting, and Evaluation in Health Care[J].Prev Med, 2010, 51(5):421-424. DOI:10.1016/j.jclinepi.2010.07.001.
[16] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志, 2015, 30(11):964-967. DOI:1002-6975(2015)11-0964-04.
[17] 刘云访,喻姣花,李素云,等.ICU成人患者气管插管非计划性拔管预防及管理的证据总结[J].护理学报, 2020, 27(3):43-48. DOI:10.16460/j.issn1008-9969.2020.03.043.
[18] 姚小云,陈红宇,胡君娥,等.癌症患者化疗相关性便秘评估与管理最佳证据总结[J].护理学报, 2020, 27(2):48-52. DOI:10.16460/j.issn1008-9969.2020.02.048.
[19] Epstein SK.Weaning from Mechanical Ventilation: Readiness Testing[EB/OL].(2018-12-04)[2020-04-28].https://www.uptodate.cn/contents/weaning-from-mechanical-ventilation-readiness-testing?search=%E6%92%A4%E6%9C%BA&source=Out%20of%20date%20-%20zh-Hans&selectedTitle=3~150.
[20] Epstein SK.Methods of Weaning from Mechanical Ventilation[EB/OL].(2019-07-15)[2020-04-28].https://www.uptodate.cn/contents/methods-of-weaning-from-mechanical-ventilation?search=%E6%92%A4%E6%9C%BA&topicRef=1652&source=related_link.
[21] Hyzy RC.Extubation Management in the Adult Intensive Care Unit[EB/OL].(2019-12-12)[2020-04-28].https://www.uptodate.cn/contents/extubation-management-in-the-adult-intensive-care unit?search=%E6%92%A4%E6%9C%BA&source=Out%20of%20date%20-%20zh-Hans.
[22] The Joanna Briggs Institute.Mechanical Ventilation: Weaning interventions in Critically Ill Adults[EB/OL].(2019-08-09)[2020-04-28].http://ovidsp.dc2.ovid.com.ezproxy.cul.columbia.edu/ovid-a/ovidweb.cgi?&S=CNOCFPJFBEEBFNBIIPAKNGEHIMAKAA00&Link+Set=S.sh.39%7c1%7csl_1
[23] The Joanna Briggs Institute.Endotracheal Tube: Extubation[EB/OL].(2020-01-28)[2020-04-28].http://ovidsp.dc2.ovid.com.ezproxy.cul.columbia.edu/ovid-a/ovidweb.cgi?&S=CNOCFPJFBEEBFNBIIPAKNGEHIMAKAA00&Link+Set=S.sh.42%7c1%7csl_190.
[24] Starnes E, Palokas M, Hinton E.Nurse-initiated Spontaneous Breathing Trials in Adult Intensive Care Unit Patients[J].JBI Database System Rev Implement Rep, 2019, 17(11):2248-2264. DOI:10.11124/JBISRIR-2017-004025.
[25] Rose L, Schultz MJ, Cardwell CR, et al.Automated Versus Non-automated Weaning for Reducing the Duration of Mechanical Ventilation for Critically Ill Adults and Children (Review)[J].Crit Care, 2015, 19(1):48. DOI:10.1186/s13054-015-0755-6.
[26] Burns KEA, Lellouche F, Nisenbaum R, et al.Automated Weaning and Sbt Systems Versus Non-automated Weaning Strategies for Weaning Time in Invasively Ventilated Critically Ill Adults (Review)[J].Database Syst Rev, 2014(9): CD008638. DOI:10.1002/14651858.CD008638.pub2.
[27] Burns KEA.Noninvasive Positive-pressure Ventilation as a Weaning Strategy for Intubated Adults with Respiratory Failure (Review)[J].Cochrane Database Syst Rev,2013(12): CD004127. DOI:10.1002/14651858.CD004127.pub3.
[28] Yeung J, Couper K, Ryan EG, et al.Non-invasive Ventilation as a Strategy for Weaning from Invasive Mechanical Ventilation: A Systematic Review And Bayesian Meta-analysis[J].Intensive Care Med, 2018,44(12):2192-2204. DOI:10.1007/s00134-018-5434-z.
[29] Meade M, Guyatt G, Cook D, et al.Predicting Success in Weaning from Mechanical Ventilation[J].Chest, 2001, 120(6 Suppl):400-424. DOI:10.1378/chest.120.6_suppl.400s.
[30] Blackwood B, Alderdice F, Burns KE, et al.Protocolized Versus Non-protocolized Weaning for Reducing the Duration of Mechanical Ventilation in Critically Ill Adult Patients[J].Cochrane Database Syst Rev,2010(5):CD006904. DOI:10.1002/14651858.CD006904.pub3.
[31] François B, Bellissant E, Gissot V, et al.12-h Pretreatment with Methylprednisolone Versus Placebo for Prevention of Postextubation Laryngeal Oedema: A Randomised Double-blind Trial[J].Lancet, 2007, 369(9567):1083-1089. DOI:10.1016/S0140-6736(07)60526-1.
[32] Beuret P, Roux C, Auclair A, et al.Interest of an Objective Evaluation of Cough During Weaning from Mechanical Ventilation[J].Intensive Care Med, 2009, 35(6):1090-1093. DOI:10.1007/s00134-009-1404-9.
[33] Salam A, Tilluckdharry L, Amoateng-Adjepong Y, et al.Neurologic Status, Cough, Secretions and Extubation Outcomes[J].Intensive Care Med,2004,30(7):1334-1339. DOI:10.1007/s00134-004-2231-7.
[34] Chao C, Sung M, Cheng K, et al.Prognostic Factors and Outcomes of Unplanned Extubation[J].Sci Rep,2017,7(1): 8636. DOI:10.1038/s41598-017-08867-1.
[35] Hess DR, Kacmarek RM.Essentials of Mechanical Ventilation(Fourth Edition)[M].New York:McGraw-Hill Education, 2019.
[36] Blackwood B, Alderdice F, Burns K, et al.Use of Weaning Protocols for Reducing Duration of Mechanical Ventilation in Critically Ill Adult Patients: Cochrane Systematic Review and Meta-analysis[J].BMJ,2011,342:c7237. DOI:10.1136/bmj.c7237.
[37] Burns KEA, Soliman I, Adhikari NKJ, et al.Trials Directly Comparing Alternative Spontaneous Breathing Trial Techniques: A Systematic Review and Meta-analysis[J].Crit Care, 2017, 21(1):127. DOI:10.1186/s13054-017-1698-x.
[38] 中华医学会重症医学分会.中国成人ICU镇痛和镇静治疗指南[J].中华危重病急救医学, 2018, 30(6):497-514. DOI:10.12056/j.issn.1006-2785.2018.40.16.2018-1547.
[39] Thille AW, Boissier F, Ben Ghezala H, et al.Risk Factors for and Prediction by Caregivers of Extubation Failure in ICU Patients[J].Crit Care Med, 2015,43(3):613-620. DOI:10.1097/CCM.0000000000000748.
[40] Zhou T, Zhang HP, Chen WW, et al.Cuff-leak Test for Predicting Postextubation Airway Complications:A Systematic Review[J].J Evid Based Med, 2011, 4(4):242-254. DOI:10.1111/j.1756-5391.2011.01160.x.
[41] 令狐昌莲,张静萍.ICU护士对机械通气患者撤机指征知信行问卷的编制[J].现代临床护理, 2019, 18(9):48-54. DOI:10.3969/j.issn.1671-8283.2019.09.009.
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