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对重症儿童的呼吸器物理治疗:对建议的担忧
1Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. shime@koto.kpu-m.ac.jp.
Journal of intensive care
|December 19, 2024
概括
2023年日本针对重症患者的临床指南可能会误解儿童呼吸器物理治疗建议. 证据支持像易受影响的定位这样的具体干预措施,但更广泛的建议需要修订,以避免伤害.
科学领域:
- 临界护理医学 临界护理医学
- 儿科康复儿童康复中心
- 呼吸系统疗法 呼吸系统疗法
背景情况:
- 日本重症监护医学学会发表了"2023年日本临床实践指南,重症患者康复".
- 一项批判性审查发现了有关机械通风儿童呼吸物理治疗的指南中的潜在问题.
- 现有证据支持具体干预措施,但目前的建议可能导致误解.
研究的目的:
- 评估临床问题的适当性和在2023年日本指导方针内对机械通风儿童的呼吸物理治疗的建议.
- 突出与目前的建议有关呼吸系统物理治疗在儿科重症监护的潜在风险.
- 倡导对指南进行修订,以确保准确和安全的患者护理.
主要方法:
- 在"日本临床实践指南重症患者康复2023年"中对呼吸器物理治疗的临床问题和建议的分析.
- 审查证据基础,包括随机对照试验的倾向性定位.
- 将指导方针建议与有关呼吸系统物理治疗的已有证据进行比较,以治疗 bronchiolitis 等儿科疾病.
主要成果:
- 该指南对呼吸器物理治疗的建议虽然基于对倾斜定位的有限证据,但有可能被误解为适用于所有呼吸器物理治疗干预措施.
- 由于缺乏益处和潜在的不良事件,有大量证据反对为患有支气管炎的婴儿进行常规胸部物理治疗.
- 当前的建议可能无法充分区分基于证据的干预措施和缺乏支持或被证明有害的干预措施.
结论:
- 在2023年日本指南中,呼吸器物理治疗的临床问题和建议需要对机械通风儿童进行修订.
- 需要澄清,以区分具体的,基于证据的干预措施和一般的物理治疗方法.
- 修订指南至关重要,以防止潜在的伤害,并确保遵守儿科重症监护呼吸管理的最佳实践.
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