碳青霉烯类耐药革兰阴性菌(CRGNB)的广泛播散是一个全球性的公共卫生问题。CRGNB临床分离株通常呈现广泛耐药或全耐药,对其感染的抗菌治疗方案有限、死亡率高。由感染病临床诊疗、临床微生物、临床药理、医院感染控制及指南方法学等多...碳青霉烯类耐药革兰阴性菌(CRGNB)的广泛播散是一个全球性的公共卫生问题。CRGNB临床分离株通常呈现广泛耐药或全耐药,对其感染的抗菌治疗方案有限、死亡率高。由感染病临床诊疗、临床微生物、临床药理、医院感染控制及指南方法学等多学科专家组成的指南制定小组,根据现有科学证据制定了本临床实践指南,以解答有关CRGNB检测、抗菌治疗及感染预防控制的系列临床优先问题。本指南聚焦于碳青霉烯类耐药肠杆菌目细菌、碳青霉烯类耐药鲍曼不动杆菌和碳青霉烯类耐药铜绿假单胞菌,从当前临床实践的角度提出16个临床问题,采用人群、干预、对照及预后(population,intervention,comparator,outcomes,PICO)格式转换为研究问题,全面收集和综合分析相关研究证据。采用推荐的分级、评估、制定与评价(grading of recommendations,assessment,development and evaluation,GRADE)方法评估相应干预措施的证据体质量、效益及风险,从而制定推荐意见或建议。随机对照临床试验及系统评价获得的结果被优先用于治疗相关临床问题的推荐证据。在缺乏随机对照临床试验的情况下,观察性研究、非对照研究和专家意见被考虑作为补充证据。推荐意见分为强推荐或弱推荐(有条件推荐)。结合中国的临床实践经验,本指南同时提出实施建议,便于指南推荐意见的临床实施。本指南对耐药菌感染诊疗相关的临床医师等多学科专业人员具有参考价值。展开更多
Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the c...Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based recommendations can be made regarding many aspects of the acute management of ALI/ARDS that will hopefully translate into improved outcomes for the critically ill patient. The guidelines will be updated when some important new knowledge becomes available.展开更多
文摘碳青霉烯类耐药革兰阴性菌(CRGNB)的广泛播散是一个全球性的公共卫生问题。CRGNB临床分离株通常呈现广泛耐药或全耐药,对其感染的抗菌治疗方案有限、死亡率高。由感染病临床诊疗、临床微生物、临床药理、医院感染控制及指南方法学等多学科专家组成的指南制定小组,根据现有科学证据制定了本临床实践指南,以解答有关CRGNB检测、抗菌治疗及感染预防控制的系列临床优先问题。本指南聚焦于碳青霉烯类耐药肠杆菌目细菌、碳青霉烯类耐药鲍曼不动杆菌和碳青霉烯类耐药铜绿假单胞菌,从当前临床实践的角度提出16个临床问题,采用人群、干预、对照及预后(population,intervention,comparator,outcomes,PICO)格式转换为研究问题,全面收集和综合分析相关研究证据。采用推荐的分级、评估、制定与评价(grading of recommendations,assessment,development and evaluation,GRADE)方法评估相应干预措施的证据体质量、效益及风险,从而制定推荐意见或建议。随机对照临床试验及系统评价获得的结果被优先用于治疗相关临床问题的推荐证据。在缺乏随机对照临床试验的情况下,观察性研究、非对照研究和专家意见被考虑作为补充证据。推荐意见分为强推荐或弱推荐(有条件推荐)。结合中国的临床实践经验,本指南同时提出实施建议,便于指南推荐意见的临床实施。本指南对耐药菌感染诊疗相关的临床医师等多学科专业人员具有参考价值。
文摘Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based recommendations can be made regarding many aspects of the acute management of ALI/ARDS that will hopefully translate into improved outcomes for the critically ill patient. The guidelines will be updated when some important new knowledge becomes available.
