机械通气患儿气管插管非计划性拔管预防策略的最佳证据总结

目的 提炼并总结儿科重症监护病房（pediatric intensive care unit，PICU）机械通气患儿气管插管非计划性拔管预防策略的最佳证据，为临床实践提供参考依据。 方法 系统检索国内外计算机决策支持系统、指南网、数据库及相关学会网站中与机械通气患儿气管插管非计划性拔管预防策略有关的文献，检索时限为2010年1月—2022年1月，文献类型包括临床决策、指南、证据总结、系统评价、专家共识。由4名研究者对纳入文献进行评价和证据提取。 结果 共纳入14篇文献，其中指南6篇、专家共识2篇、系统评价6篇。从气管插管非计划性拔管的危险因素、气管插管及气道管理、镇静评估与管理、镇痛评估与管理、谵妄监测与预防、组织管理6个方面总结了25条最佳证据。 结论 该研究总结的最佳证据为PICU机械通气患儿气管插管非计划性拔管的预防提供循证依据。应用证据前，医护人员应评估临床情景及障碍因素，促使证据有效、安全地向临床转化。

Summary of the best evidence for the preventive strategies of unplanned endotracheal extubation in children with mechanical ventilation

Objective Through systematic evidence retrieval and literature quality evaluation，the best evidence on the preventive strategies of unplanned extubation of tracheal tubes in pediatric intensive care units （PICU） was extracted and summarized，so as to provide research-based evidence for clinical practice. Methods The literature related to the preventive strategies of unplanned extubation of endotracheal intubation in children with mechanical ventilation were systematically searched in domestic and foreign computer decision support systems，guide networks，databases and websites of relevant societies. The retrieval time limit is from January 2010 to January 2022. The literature types cover clinical decision-making，clinical practice guidelines，evidence summaries，systematic evaluations and expert consensuses. 5 different types of publications were retrieved and evaluated by 4 experts. Results A total of 14 publications were included，involving 6 guidelines，2 expert consensuses，6 systematic reviews. 25 pieces of best evidence of preventive strategies in 6 aspects，namely risk factors，tracheal intubation and airway management，sedation evaluation and management，analgesia evaluation and management，delirium monitoring and prevention，and PICU human resources and facilities were summarized. Conclusion The best evidence summarized in this study provides an evidence-based basis for the prevention of unplanned extubation of tracheal intubation in children with PICU mechanical ventilation. Before applying the evidence，medical workers should evaluate the clinical situation and obstacle factors，so as to promote the effective and safe transformation of the evidence into clinical practice.