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    2010美国呼吸治疗学会气管内吸痰时的临床指南

    时间:2011-12-25 16:17 来源:未知 作者:周明根 点击:
      该临床指南是根据从1990年1月到2009年10月之间已发表的电子文献和美国医学索引MEDLINE,CINAHL,和Cochrane Library databases医学资料库的数据,并且通过对气管内吸痰总共114例的临床跟踪,62例回顾和6例荟萃分析对原有的临床指南做出的更新。
     
      该指南当中,有10项建议是按照推荐分级的评估,制定与评价(GRADE)的标准提出的。
    1.气管内吸痰仅仅是在病患有痰的时候,而不是常规性的。也就是说病患有需要吸痰的指征时才吸痰(It is recommended that endotracheal suctioning should be performed only when secretions are present and not routinely) ;
     
    2.如果病患在吸痰时,临床上有明显的血氧饱和度下降的问题,建议吸痰前提高氧浓度(It is suggested that pre-oxygenation be considered if the patient has a clinically important reduction in oxygen saturation with suctioning);建议在吸痰前的30-60秒,向儿童和成人提供100%的氧;向婴儿提供基础氧浓度的10%(10% increase of baseline in neonates);
     
    3.建议在给呼吸机上的病患吸痰时不要让病患与呼吸机分离(Performing suctioning without disconnecting the patient from the ventilator is suggested);
     
    4.基于对婴儿和儿童所做的研究证据,建议使用浅吸痰而不是深吸痰。主要是避免深吸痰有可能会造成气管黏膜的损伤(Use of shallow suction is suggested instead of deep suction, based on evidence from infant and pediatric studies);
     
    5.建议不要在气管内吸痰前常规的使用生理盐水滴注。(It is suggested that routine use of normal saline instillation prior to endotracheal suction should not be performed);
     
    6.建议对使用高浓度的氧或PEEP,或具有肺泡重新塌陷风险的成人和婴儿采用封闭式吸痰(The use of closed suction is suggested for adults with high FiO2,or PEEP,or at risk for lung derecruitment, and for neonates);
     
    7.建议对婴儿采取封闭式的气管内吸痰(Endotracheal suctioning without disconnection(closed system) is suggested in neonates);
     
    8.如果有急性肺损伤的病患发生由于吸痰导致的肺(泡)重新塌陷,建议避免将病患与呼吸机断开和采用(吸痰后的)肺复张(Avoidance of disconnection and use of lung recruitment maneuvers are suggested if suctioning-induced lung derecruitment occurs in patients with acute lung injury);
     
    9.建议成人和儿童使用的吸痰管(直径)要小于他们使用的气管插管的直径的50%,婴儿则要小于70%(It is suggested that a suction catheter is used that occludes less than 50% the lumen of the endotracheal tube in children and adults, and less than 70% in infants);
     
    10.建议每次吸痰的时间不要超过15秒钟(It is suggested that the duration of the suctioning event be limited to less than 15 seconds);
     
     
    Endotracheal suctioning of mechanically ventilated patients with artificial airways. RESPIRATORY CARE . 2010 ,VOL 55 NO 6

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