影响重症监护单位多学科临床决策的因素:系统性审查和混合方法元合成
Kenki Matsumoto1,2, Brigitta Fazzini1,2, Hannah Malcolm1,2
1Adult Critical Care Unit (ACCU), The Royal London Hospital, Barts Health NHS Trust, London, UK.
BJA open
|October 13, 2025
概括
在重症监护室 (ICU) 的临床决策是复杂的. 这次审查确定了四个可修改的主题 - 人,团队,系统和患者因素 - 影响器官支持治疗决策.
科学领域:
- 关键护理医学 关键护理医学
- 医疗保健决策 - - 医疗保健决策
- 临床实践 临床实践
背景情况:
- 重症监护室 (ICU) 对器官支持的决策是复杂的,并且在临床医生之间有所不同.
- 影响这些关键决策的因素尚不清楚.
- 国际公认的指导方针并没有完全规范临床判断.
研究的目的:
- 系统地审查关于ICU中器官支持治疗的决策过程的证据.
- 确定影响这些决定的因素.
- 根据当前的证据生成一个决策模型.
主要方法:
- 在PubMed,Embase和CINAHL数据库中进行系统的文献搜索.
- 包括探索影响器官支持决策的因素的研究.
- 混合方法的元合成,以确定模型生成的主题和子主题.
主要成果:
- 对33项研究的分析 (来自8967个记录) 显示,决策可以是线性的,由患者因素驱动.
- 确定了11个因素,影响和挑战临床医生的决策.
- 出现了四个关键主题:人类,团队,系统和患者因素作为可修改的影响.
结论:
- 器官支持治疗在ICU的决定是复杂的,并受到四个可修改的主题的影响.
- 需要进一步的研究来开发改善决策的干预措施.
- 调查决策过程对患者结果的影响至关重要.
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