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Báo cáo y học: "Practising evidence-based medicine: the design and implementation of a multidisciplinary team-driven extubation protocol"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Practising evidence-based medicine: the design and implementation of a multidisciplinary team-driven extubation protocol. | Available online http ccforum.eom content 5 6 349 Research article Practising evidence-based medicine the design and implementation of a multidisciplinary team-driven extubation protocol Pik Kei O Chan Sandra Fischer1- Thomas E Stewart1- David C Hallett1 Patricia Hynes-Gay1- Stephen E Lapinsky1 Rod MacDonald1 and Sangeeta Mehta1 Department of Medicine Queen Elisabeth Hospital Intensive Care Unit Kowloon Hong Kong China Interdepartmental Division of Critical Care and Department of Medicine Mount Sinai Hospital Toronto Ontario Canada Correspondence Sangeeta Mehta geeta.mehta@utoronto.ca Received 12 September 2001 Accepted 20 September 2001 Published 26 October 2001 See Commentaries page 283 Critical Care 2001 5 349-354 2001 Chan et al. licensee BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Background Evidence from recent literature shows that protocol-directed extubation is a useful approach to liberate patients from mechanical ventilation MV . However research evidence does not necessarily provide guidance on how to implement changes in individual intensive care units ICUs . We conducted the present study to determine whether such an evidence-based strategy can be implemented safely and effectively using a multidisciplinary team MDT approach. Method We designed a MDT-driven extubation protocol. Multiple meetings were held to encourage constructive criticism of the design by attending physicians nurses and respiratory care practitioners RCPs in order to define a protocol that was evidence based and acceptable to all clinical staff involved in the process of extubation. It was subsequently implemented and evaluated in our medical surgical ICU. Outcomes included response of the MDT to the initiative duration of MV and stay in the ICU as well as reintubation rate. Results The MDT responded favourably to the design and implementation of this MDT-driven extubation protocol because it provided greater autonomy to the staff. Outcomes reported in the