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首页> 外文期刊>BMJ Open Respiratory Research >Management of tracheostomies in the intensive care unit: a scoping review
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Management of tracheostomies in the intensive care unit: a scoping review

机译：在重症监护统计单体中的气管遗言管理：一个范围审查

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Objectives While there is an extensive body of literature surrounding the decision to insert, and methods for inserting, a tracheostomy, the optimal management of tracheostomies within the intensive care unit (ICU) from after insertion until ICU discharge is not well understood. The objective was to identify and map the key concepts relating to, and identify research priorities for, postinsertion management of adult patients with tracheostomies in the ICU.Design Scoping review of the literature.Data sources PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature were searched from inception to 3 October 2019. Additional sources were searched for published and unpublished literature.Eligibility criteria We included studies of any methodology that addressed the a priori key questions relating to tracheostomy management in the ICU. No restrictions were placed on language or year of publication.Data extraction and synthesis Titles and abstracts were screened by two reviewers. Studies that met inclusion criteria were reviewed in full by two reviewers, with discrepancies resolved by a third. Data were extracted for included studies, and results mapped along the prespecified research questions.Results 6132 articles were screened, and 102 articles were included for detailed analysis. Protocolised weaning was found to be successful in liberating patients from the ventilator in several cohort studies. Observational studies showed that strategies that use T-pieces and high-flow oxygen delivery improve weaning success. Several lines of evidence, including one clinical trial, support early cuff deflation as a safe and effective strategy as it results in a reduced time to wean, shorter ICU stays and fewer complications. Early tracheostomy downsizing and/or switching to cuffless tubes was found to be of benefit in one study. A substantial body of evidence supports the use of speaking valves to facilitate communication. While this does not influence time to wean or incidence of complications, it is associated with a major benefit in patient satisfaction and experience. Use of care bundles and multidisciplinary team approaches have been associated with reduced complications and improved outcomes in several observational studies.Conclusions The limited body of evidence supports use of weaning protocols, early cuff deflation, use of speaking valves and multidisciplinary approaches. Clinical trials examining post-tracheostomy management strategies in ICUs are a priority.
机译：目标虽然有一个广泛的文学身体围绕着插入的决定，以及用于插入的方法，一种气管造口术，在插入后，在ICU放电直到ICU放电之前的重症监护单元（ICU）内的气管源的最佳管理尚不清楚。目的是识别和绘制与ICU中的学生气管术患者的研究优先考虑有关的关键概念，并识别ICU中的气管术患者的研究优先考虑.DATA来源的审查审查，培训和盟军的护理和累积指数从2009年10月3日开始搜查了文学。出版和未发表的文献中搜索了其他来源。从ICU中的任何方法中，我们还包括任何方法的研究，该方法包括解决了与ICU中的气管造影管理有关的先验关键问题。没有限制出版物或出版物的语言。提取和综合标题和摘要被两名审稿人筛选。符合纳入标准的研究全面审查了两名审稿人，其中第三次差异解决。提取数据的包括研究，并沿着预先确定的研究问题映射结果。筛选出6132篇文章，包括102篇文章进行详细分析。发现协议断奶在几个队列研究中取得了成功的解放出呼吸机的患者。观察性研究表明，使用T型碎片和高流量氧气输送的策略改善了断奶成功。几种证据，包括一个临床试验，支持早期的袖带通货紧缩作为一种安全有效的策略，因为它导致了减少时间的时间，更短的ICU保持和更少的并发症。在一项研究中，发现早期气管缩小和/或切换到无齿状管中的益处。大量证据支持使用说话的阀门来促进沟通。虽然这不会影响混合物或并发症发病率，但它与患者满意度和经验的主要益处有关。关心捆绑和多学科团队方法的使用已经与几种观察研究中的复杂性和改善的结果相关联。结论有限的证据支持使用断奶协议，早期袖带通货紧缩，使用说话阀门和多学科方法。检查ICU后气管造口管理策略的临床试验是一个优先事项。

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