成人ICU患者中较高或较低的氧化目标:一个快速实践指南
Morten Hylander Møller1,2,3, Anders Granholm1,2,3, Zainab Al Duhailib3,4,5
1Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Acta anaesthesiologica Scandinavica
|December 23, 2023
概括
在重症监护病房 (ICU) 中,较高与较低的氧化目标在患者的治疗结果中显示出极小的差异. 专家建议不要设定更高的常规目标,而优先考虑更低的安全和患者价值水平.
科学领域:
- 关键护理医学 关键护理医学
- 临床实践指南 临床实践指南
- 基于证据的医学基于证据的医学.
背景情况:
- 对于成年患者来说,重症监护室 (ICU) 的最佳氧化目标仍在争论中.
- 较高的氧化目标可能会带来风险,但没有明显的好处.
- 由于安全和资源考虑,正在探索较低的氧化目标.
研究的目的:
- 为成年ICU患者提供基于证据的指导,以更高或更低的氧化目标为目标.
- 使用严格的方法制定临床实践指南.
- 为了告知临床决策有关氧气治疗在重症监护.
主要方法:
- 遵守可信的临床实践指南方法.
- 使用推评估,开发和评估 (GRADE) 的评级,以确保证据的确定性.
- 采用了17个RCT (10,248名参与者) 的证据决策框架和系统审查/元分析.
主要成果:
- 在死亡率,不良事件,中风,功能结果,认知和生活质量方面,观察到较高和较低的氧化目标之间几乎没有差异.
- 对所有结果的证据确定性被评为非常低.
- 专家组考虑了患者价值,成本,资源,公平性和可行性.
结论:
- 对成年ICU患者常规使用更高氧化度的目标发表了有条件的建议.
- 较低的氧化度目标 (SpO2 88%-92%或PaO2 8 kPa/60 mmHg) 被认为是安全的,对于大多数成年ICU患者来说都是相关的.
- 该指南强调在氧气治疗中个性化患者护理和资源管理.
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