机械通气患者拔管后氧疗方式的最佳证据总结及流程图构建

doi:10.3761/j.issn.2096-7446.2025.02.019

摘要/Abstract

摘要：

目的系统汇总机械通气患者拔管后氧疗方式的相关证据，根据最佳证据构建氧疗方式流程图，为临床医护人员氧疗决策提供参考。方法系统检索指南网站及数据库中关于机械通气患者拔管后氧疗方式的相关文献，检索时限为建库至2024年1月12日，根据相应评价标准对文献进行评价，并提取、整合证据。结果共纳入13篇文献，包括临床决策3篇、指南5篇、证据总结1篇、专家共识1篇、系统评价1篇、随机对照试验2篇；从基本原则、应用指征、应用方法、注意事项等4个方面汇总了24条最佳证据，并构建了机械通气患者拔管后氧疗方式流程图。结论该研究总结了机械通气患者拔管后氧疗方式的最佳证据并构建了氧疗流程图，可为临床规范化选择拔管后氧疗方式提供参考。

关键词: 通气机, 机械, 拔管, 氧疗, 流程图, 循证护理学

Abstract:

Objective To systematically summarize the relevant evidence of post-extubation oxygen therapy methods for mechanically ventilated patients，so as to construct a flow chart of oxygen therapy methods based on the best evidence，for providing the reference for clinical staff to make oxygen therapy decisions. Methods We systematically searched the literature on the post-extubation oxygen therapy methods for mechanically ventilated patients in guideline websites and databases（inception of the database to January 12，2024）. The literature was evaluated according to the corresponding evaluation criteria，and the evidence was extracted and integrated. Results A total of 13 literature incorporated，including three clinical decisions，five guidelines，an evidence summary，an expert consensus，a systematic review，and two randomized controlled trials. The 24 pieces of best evidence were summarized from 4 aspects，including basic principles，application indications，application methods，precautions. The post-extubation oxygen therapy flow chart for mechanically ventilated patients was constructed. Conclusion This study summarized the best evidence of post-extubation oxygen therapy for mechanically ventilated patients and constructed the flow chart of oxygen therapy，which can provide a basis for clinical standardized selection of post-extubation oxygen therapy methods.

Key words: Ventilators, Mechanical, Extubation, Oxygen Therapy, Flow Chart, Evidence-Based Nursing

贾东珲, 周红芳, 兰旭红, 韩晓萌, 王倩, 王恒阳, 张莹, 杨暐, 张志刚. 机械通气患者拔管后氧疗方式的最佳证据总结及流程图构建[J]. 中华急危重症护理杂志, 2025, 6(2): 233-239.

JIA Donghui, ZHOU Hongfang, LAN Xuhong, HAN Xiaomeng, WANG Qian, WANG Hengyang, ZHANG Ying, YANG Wei, ZHANG Zhigang. Summary of the best evidence and construction of flow chart of oxygen therapy after extubation in mechanically ventilated patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(2): 233-239.

图/表 5

参考文献 28

[1]	Thille AW, Richard JC, Brochard L. The decision to extubate in the intensive care unit[J]. Am J Respir Crit Care Med, 2013, 187(12):1294-1302.
[2]	Ouellette DR, Patel S, Girard TD, et al. Liberation from mecha-nical ventilation in critically ill adults:an official American college of chest physicians/American thoracic society clinical practice guideline:inspiratory pressure augmentation during spontaneous breathing trials,protocols minimizing sedation,and noninvasive ventilation immediately after extubation[J]. Chest, 2017, 151(1):166-180. doi: S0012-3692(16)62324-3 pmid: 27818331
[3]	Hernández G, Vaquero C, Colinas L, et al. Effect of postextu-bation high-flow nasal cannula vs noninvasive ventilation on reintubation and postextubation respiratory failure in high-risk patients:a randomized clinical trial[J]. JAMA, 2016, 316(15):1565-1574. doi: 10.1001/jama.2016.14194 pmid: 27706464
[4]	Fernando SM, Tran A, Sadeghirad B, et al. Noninvasive respira-tory support following extubation in critically ill adults:a sys-tematic review and network meta-analysis[J]. Intensive Care Med, 2022, 48(2):137-147.
[5]	林颖康, 李晓倩, 陈静, 等. 慢性阻塞性肺疾病急性加重患者撤机后序贯使用经鼻高流量氧疗对比无创正压通气临床疗效的Meta分析[J]. 中国呼吸与危重监护杂志, 2023, 22(10):727-735.
	Lin YK, Li XQ, Chen J, et al. Clinical efficacy of sequential HFNC versus NIPPV after extubation in AECOPD patients:a meta-analysis of randomized controlled trials[J]. Chin J Respir Crit Care Med, 2023, 22(10):727-735.
[6]	朱政, 胡雁, 周英凤, 等. 推动证据向临床转化(五)证据临床转化研究中的文献质量评价[J]. 护士进修杂志, 2020, 35(11):996-1000.
	Zhu Z, Hu Y, Zhou YF, et al. Promotion evidence to clinical transformation:evidence resource retrieval for the purpose of clinical transformation[J]. J Nurses Train, 2020, 35(11):996-1000.
[7]	Feng ZZ, Zhang L, Yu HC, et al. High-flow nasal cannula oxygen therapy versus non-invasive ventilation for AECOPD patients after extubation:a systematic review and meta-analysis of randomized controlled trials[J]. Int J Chron Obstruct Pulmon Dis, 2022, 17:1987-1999.
[8]	Hyzy RC. Noninvasive ventilation in adults with acute respira-tory failure:benefits and contraindications[EB/OL].(2023-05-08).[2024-01-30]. https://www.uptodate.cn/contents/noninvasive-ventilation-in-adults-with-acute-respiratory-failure-benefits-and-con-traindications?search=extubation&source=search_result&selected-Title=69-150&usage_type=default&display_rank=69.
[9]	Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines:noninvasive ventilation for acute respiratory failure[J]. Eur Respir J, 2017, 50(2):1602426.
[10]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[11]	范美荣, 陈璐, 王芸, 等. 基于最佳证据的腹膜透析患者运动指导流程图的制作[J]. 中华护理杂志, 2022, 57(11):1377-1383. doi: 10.3761/j.issn.0254-1769.2022.11.015
	Fan MR, Chen L, Wang Y, et al. Development of exercise guidance flow chart for peritoneal dialysis patients based on the best evidence[J]. Chin J Nurs, 2022, 57(11):1377-1383. doi: 10.3761/j.issn.0254-1769.2022.11.015
[12]	Hyzy RC. Extubation management in the adult intensive care unit[EB/OL].(2023-04-27)[2024-01-30]. https://www.uptoda-te.cn/contents/extubation-management-in-the-adult-intensive-care-unit?search=extubation&source=search_result&selectedTitle=3-150&usage_type=default&display_rank=3.
[13]	Hyzy RC. Complications of the endotracheal tube following initial placement:Prevention and management in adult inten-sive care unit patients[EB/OL].(2023-02-01)[2024-01-30]. https://www.uptodate.cn/contents/complications-of-the-endotrach-eal-tube-following-initial-placement-prevention-and-management-in-adult-intensive-care-unit-patients?search=extubation&source=search_result&selectedTitle=10-150&usage_type=default&dis-play_rank=10.
[14]	潘宸, 朱涵菁, 杨鹏飞, 等. ICU气管插管拔管后病人应用经鼻高流量湿化氧疗的最佳证据总结[J]. 护理研究, 2022, 36(3):421-427.
	Pan C, Zhu HJ, Yang PF, et al. Evidence summary for high-flow nasal cannula oxygen therapy in ICU patients after extubation[J]. Chin Nurs Res, 2022, 36(3):421-427.
[15]	Qaseem A, Etxeandia-Ikobaltzeta I, Fitterman N, et al. Approp-riate use of high-flow nasal oxygen in hospitalized patients for initial or postextubation management of acute respiratory failure:a clinical guideline from the American college of physicians[J]. Ann Intern Med, 2021, 174(7):977-984. doi: 10.7326/M20-7533 pmid: 33900796
[16]	Rochwerg B, Einav S, Chaudhuri D, et al. The role for high flow nasal cannula as a respiratory support strategy in adults:a clinical practice guideline[J]. Intensive Care Med, 2020, 46(12):2226-2237. doi: 10.1007/s00134-020-06312-y pmid: 33201321
[17]	Quintard H, L’Her E, Pottecher J, et al. Intubation and extuba-tion of the ICU patient[J]. Anaesth Crit Care Pain Med, 2017, 36(5):327-341.
[18]	中华医学会呼吸病学分会呼吸危重症医学学组, 中国医师协会呼吸医师分会危重症医学工作委员会. 成人经鼻高流量湿化氧疗临床规范应用专家共识[J]. 中华结核和呼吸杂志, 2019, 42(2):83-91.
	Respiratory Critical Care Medicine Group of Respiratory Medicine Branch of Chinese Medical Association,Critical Care Medicine Working Committee of Respiratory Physician Branch of Chinese Medical Doctor Association. Expert con-sensus on the application of clinical norms of nasal high-flow humidified oxygen therapy for adults[J]. Chin J Tuberc Respir Dis, 2019, 42(2):83-91.
[19]	da Silva PSL, Fonseca MCM. Unplanned endotracheal extuba-tions in the intensive care unit:systematic review,critical ap-praisal,and evidence-based recommendations[J]. Anesth Analg, 2012, 114(5):1003-1014.
[20]	Thille AW, Coudroy R, Nay MA, et al. Beneficial effects of noninvasive ventilation after extubation in obese or over-weight patients:a post hoc analysis of a randomized clinical trial[J]. Am J Respir Crit Care Med, 2022, 205(4):440-449.
[21]	胡述立, 汤浩, 范学朋. 经鼻高流量氧疗与无创正压通气在不同APACHE Ⅱ评分老年AECOPD患者中拔管后的治疗效果研究[J]. 中国全科医学, 2018, 21(15):1790-1795. doi: 10.3969/j.issn.1007-9572.2017.00.258
	Hu SL, Tang H, Fan XP. Therapeutic efficacy of high-flow nasal cannula and noninvasive positive-pressure ventilation in AECOPD patients with various APACHE Ⅱ scores after extubation[J]. Chin Gen Pract, 2018, 21(15):1790-1795.
[22]	郄晓亮. 拔管后经鼻高流量吸氧对成人患者再插管率影响的meta分析[D]. 石家庄: 河北医科大学, 2018.
	Qie XL. A meta analysis on influence of high-flow nasal cannula for the reintubation rate in adult patients after extubation[D]. Shijiazhuang: Hebei Medical University, 2018.
[23]	Ni YN, Luo J, Yu H, et al. Can high-flow nasal cannula reduce the rate of endotracheal intubation in adult patients with acute respiratory failure compared with conventional oxygen therapy and noninvasive positive pressure ventilation:a systematic review and meta-analysis[J]. Chest, 2017, 151(4):764-775.
[24]	Hernández G, Vaquero C, González P, et al. Effect of postextu-bation high-flow nasal cannula vs conventional oxygen the-rapy on reintubation in low-risk patients:a randomized clini-cal trial[J]. JAMA, 2016, 315(13):1354-1361. doi: 10.1001/jama.2016.2711 pmid: 26975498
[25]	孙波, 张天卿, 胡雪忠, 等. 经鼻高流量氧疗在ICU气管插管拔管后呼吸衰竭患者中的应用[J]. 中华急诊医学杂志, 2020, 29(2):279-283.
	Sun B, Zhang TQ, Hu XZ, et al. Application of nasal high flow oxygen therapy in patients with respiratory failure after tracheal intubation and extubation in ICU[J]. Chin J Emerg Med, 2020, 29(2):279-283.
[26]	Li WR, Zhang Y, Wang ZZ, et al. The risk factors of reintu-bation in intensive care unit patients on mechanical ventila-tion:a systematic review and meta-analysis[J]. Intensive Crit Care Nurs, 2023, 74:103340.
[27]	Li PB, Sun ZH, Xu JY. Unplanned extubation among critically ill adults:a systematic review and meta-analysis[J]. Intensive Crit Care Nurs, 2022, 70:103219.
[28]	周红芳, 兰旭红, 贾东珲, 等. ICU成人气管插管患者围拔管期管理的最佳证据总结[J]. 中华急危重症护理杂志, 2024, 5(1):33-39.
	Zhou HF, Lan XH, Jia DH, et al. Summary of the best eviden-ces for the management of the periextubation period for ICU adult patients with tracheal intubation[J]. Chin J Emerg Crit Care Nurs, 2024, 5(1):33-39.