目的发布欧洲重症医学学会(European Society of Intensive Care Medicine, ESICM)关于神经重症监护患者液体治疗的专家共识和临床实践推荐意见。设计在2016年10月召开的ESICM LIVE 2016会议上召集了一个由22名国际专家组成的共识委员会...
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目的发布欧洲重症医学学会(European Society of Intensive Care Medicine, ESICM)关于神经重症监护患者液体治疗的专家共识和临床实践推荐意见。设计在2016年10月召开的ESICM LIVE 2016会议上召集了一个由22名国际专家组成的共识委员会,随后委员会成员通过电话会议和在线讨论制定本专家共识。方法回顾人群、干预、对比和结局(population, intervention,comparison, and outcomes, PICO)问题,根据需要进行更新并得到证据概要。本共识关注3个主要议题:(1)神经重症监护患者的液体复苏和维持;(2)高渗液体在颅内压控制中的应用;(3)蛛网膜下腔出血后迟发性脑缺血的液体管理。经过广泛的文献检索,应用推荐分级的评估、制订与评价(g.ading.f Recommendations Assessment, Development and Evaluation, g.ADE)系统原则评估证据质量(从高到极低),制定治疗推荐(强或弱),并在适用时发布最佳实践声明。基于文献和专家意见提供的综合证据,应用改良德尔菲方法(使用序贯方法以避免偏倚和误解)产生最终共识声明。结果最终共识包含总共32条声明,其中13条为强推荐,17条为弱推荐,另外2条声明未提供推荐意见。结论我们发布了一份关于神经重症监护患者液体治疗的共识声明和临床实践推荐。
OBJECTIVE:To study the impact of neurolog.c prog.ostication on the decision to withdraw life-sustaining.therapies(LST)in comatose patients resuscitated after cardiac ***:The authors prospectively studied a consecutive...
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OBJECTIVE:To study the impact of neurolog.c prog.ostication on the decision to withdraw life-sustaining.therapies(LST)in comatose patients resuscitated after cardiac ***:The authors prospectively studied a consecutive series of post-resuscitation comatose patients referred for neurolog.c prog.ostication at a sing.e center for 4 *** most patients,neurolog.c prog.ostication was not soug.t due to early death or rapid return to *** was based on g.asg.w Coma Score(g.S)and Brainstem Reflex Score(BRS),with EEg.and cortical evoked potentials(CEP),which were g.aded as benig.,uncertain,and *** outcomes were as follows:survivors(g.oup S),brain or cardiac death(g.oup D),and death from withdrawal of life sustaining.therapy(g.oup W).In g.oup W,the time interval to withdrawal of LST was analyzed by EEg.and CEP ***:Of 58 patients studied,10 were in g.oup S,8 in g.oup D,and 40 in g.oup *** median g.S and BRS was similar for all g.oups with sig.ificant improvement noted in g.oup S,but not in g.oup D or g.oup *** g.oup W,CEP g.ade correlated with the median duration of continued therapy before a decision to withdraw LST:7 days for benig. CEP,2 days for uncertain CEP,and 1 day for malig.ant CEP,p = ***:In patients with poor neurolog.c recovery early after resuscitation from cardiac arrest,physicians appear to use the cortical evoked potential g.ade to estimate *** evoked potential g.ade correlated with the waiting.time until life sustaining.therapies were withdrawn after no improvement in neurolog.c examination was seen.
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