Original Article
Summary of the best evidence for the management of endotracheal intubation and extubation in adult mechanically ventilated patients in intensive care unit based on guidelines and randomized controlled trials
Liu Xiumei, Gong Ping, Kang Jian, He Surui
Published 2021-08-28
Cite as Chin Crit Care Med, 2021, 33(8): 927-932. DOI: 10.3760/cma.j.cn121430-20210412-00536
Abstract
ObjectiveTo summarize the best evidence for extubation management of adult patients with mechanical ventilation in the intensive care unit (ICU), which will provide practical guidelines for medical staffs.
MethodsBMJ best clinical practice, UpToDate clinical consultants, Guidelines International Network (GIN), National Guideline Clearinghouse (NGC), National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), Registered Nurses' Association of Ontario (RNAO), Medlive guide, Cochrane Library, JBI evidence-based Health Care Center Database, Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ebsco, SinoMed, CNKI, Wanfang Database, etc., were systematically searched. Clinical guidelines, systematic reviews, expert consensus, and randomized controlled trial (RCT) studies were searched from the above database unit August 31st, 2020. Literature quality was evaluated using Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREEⅡ), JBI quality evaluation tools, and Cochrane risk bias assessment. Two researchers evaluated the quality of the included literature respectively, and then the best evidence of endotracheal intubation and extubation management in ICU adult patients with mechanical ventilation was extracted and summarized.
ResultsA total of 12 articles were collected, including 2 guidelines, 5 systematic reviews, 2 expert consensus, and 3 RCTs. This paper summarizes 17 best evidences on extubation management of adult patients with mechanical ventilation in ICU, including accurate pre-extubation assessment, personnel and equipment, medication, posture, oxygen therapy, airway management, and post-extubation monitoring.
ConclusionMedical staff should choose the best evidence that meets the requirements of the clinical settings and standardize the management of patients after extubation to reduce the incidence of complications and re-intubation rate to ensure the safety of patients, which will be very important for the management of ICU adult patients with mechanical ventilation after extubation.
Key words:
Intensive care unit; Mechanical ventilation; Adult; Endotracheal intubation; Extubation
Contributor Information
Liu Xiumei
Department of ICU, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning, China
Gong Ping
Department of EICU, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning, China
Kang Jian
Department of EICU, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning, China
He Surui
Department of EICU, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning, China
