Practising evidence-based medicine the design and implementation of a multidisciplinary team-driven extubation protocol 英文参考文献.docVIP

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Practising evidence-based medicine the design and implementation of a multidisciplinary team-driven extubation protocol 英文参考文献.doc

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Practising evidence-based medicine the design and implementation of a multidisciplinary team-driven extubation protocol 英文参考文献

Available online /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 Fischer?, Thomas E Stewart?, David C Hallett?, Patricia Hynes-Gay?, Stephen E Lapinsky?, Rod MacDonald? and Sangeeta Mehta? *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 Critical Care 2001, 5:349-354 ? 2001 Chan et al., licensee BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) See Commentaries, page 283 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, beca