《2001ACCP詢證指南：脫機(jī)與中止通氣支持》內(nèi)容預(yù)覽

To address many of these issues, the Agency for Health- care Policy and Research (AHCPR) charged the McMaster University Evidence Based Practice Center to do a com-prehensive evidence-based review of many of the issues involved in ventilator weaning/discontinuation. Led by Deborah Cook MD, an exhaustive review of several thou-sand articles in the world literature resulted in a compre- hensive assessment of the state of the literature in 1999.

At the same time, the American College of Chest Physi-cians (ACCP), the Society for Critical Care Medicine (SCCM), and the American Association for Respiratory Care (AARC) formed a task force to produce evidence-based clinical practice guidelines for managing the venti-lator-dependent patient during the discontinuation process. The charge of this task force was to utilize the McMaster AHCPR report as well as their own literature review to address the following 5 issues: (1) the pathophysiology of ventilator dependence; (2) the criteria for identifying pa-tients who are capable of ventilator discontinuation; (3) ventilator management strategies to maximize discontinu-ation potential; (4) the role of tracheotomy; and (5) the role of long-term facilities. Review/writing teams were formed for each of these issues.

From these evidence-based reviews, a series of rec-ommendations were developed by the task force, which are the basis of this report. Each recommendation is followed by a review of the supporting evidence, in-cluding an assessment of the strength of the evidence (Table 1). As there were many areas in which evidence was weak or absent, the expert opinion of the task force was relied on to “fill in the gaps.” Consensus was reached,first, by team discussions and, later, through the re-peated cycling of the draft through all members of the task force.

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