實證醫學競賽組別：( B ) 報告者：洪毓謙醫師.ppt

1、實證醫學競賽組別：( B )報告者：洪毓謙 醫師,PICO,問題類型：治療； 診斷； 傷害； 預後 P : patients with ventilator I : head elevation C : supine O : prevent ventilator related pneumonia,Database Source,資料庫資源： Pubmed,Search Terms,搜尋關鍵字： ventilator ventilator and pneumonia ventilator and pneumonia and position head of bed elevation,Sear

2、ch Strategy,搜尋歷程(請描述如何縮小搜尋範圍)： 未限制條件時ventilator and pneumonia 總搜得篇數 = 2382 限制條件：Search ventilator and pneumonia Limits: Meta-Analysis, Randomized Controlled Trial, Middle Aged + Aged: 45+ years, Aged: 65+ years 搜得篇數 = 114 限制條件：Search ventilator and pneumonia and position Limits: Meta-Analysis, Rando

3、mized Controlled Trial, Middle Aged + Aged: 45+ years, Aged: 65+ years 搜得篇數 = 8 限制條件： 搜得篇數 =,第一篇 Critically Appraised Article,出處：Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: Prevention journal of critical careVolume 23, Issue 1, Pages 126-137 (March

4、2008) 研究設計：Purpose To develop evidence-based guidelines for the prevention of VAP.Data Sources MEDLINE, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews and Register of Controlled Trials. Study Selection The authors systematically searched for all relevant randomized, controlled trial

5、s and systematic reviews on the topic of prevention of VAP in adults that were published from 1980 to October 1, 2006. Data Extraction Independently and in duplicate, the panel scored the internal validity of each trial. Effect size, confidence intervals, and homogeneity of the results were scored u

6、sing predefined definitions. Scores for the safety, feasibility, and economic issues were assigned based on consensus of the guideline panel. 研究結果分析(要有數據)：The following statements were used: recommend, consider, do not recommend, and no recommendation due to insufficient or conflicting evidence. 結論：

7、We recommend: head of bed elevation to 45 (when impossible, as near to 45 as possible should be considered).,第二篇 Critically Appraised Article,出處：Reducing the risk of ventilator-acquired pneumonia through head of bed elevation. Nurs Crit Care. 2007 Nov-Dec;12(6):287-94. 研究設計：METHODS: The design is qu

8、antitative in nature, using a randomized controlled trial. The method involves adult ventilated patients being randomly assigned to one of two positions, i.e. 45 degrees raised head of bed (treatment group) or 25 degrees raised head of bed (control group). 研究結果分析(要有數據)：Data collection relied upon th

9、e diagnosis of clinically suspected and microbiologically confirmed pneumonia defined by the Consensus Conference on VAP. RESULTS: Thirty patients were included in the study-17 in the treatment group and 13 in the control group. Results showed that 29% (five) in the treatment group and 54% (seven) i

10、n the control group contracted VAP (P 0.176). 結論：There was a trend towards a reduction in VAP in the patients nursed at 45 degrees. However, because of the sample size this difference did not reach statistical significance.,Clinical Bottom line,結論：(1)We prefer head of bed elevation with 45 degree to prevent VAP.(2)there is no difference between 25 degree and 45 degree in head of bed elevation 證據強度(level of evidence)：(1): Ia (2): Ib Grade of recommendation：A,