Romain Sonneville, Eric Azabou, Pierre Bailly, Sarah Benghanem, Gilles De Almeida Cardoso, Pierre Claquin, David Cortier, Augustin Gaudemer, Bertrand Hermann, Pierre Jaquet, Virginie Lambrecq, Camille Legouy, Stéphane Legriel, Thomas Rambaud, Benjamin Rohaut, Benjamine Sarton, Stein Silva, Tarek Sharshar, Fabio Silvio Taccone, Dominique Vodovar, Nicolas Weiss, Charles Cerf
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引用次数: 0
Abstract
Introduction: Acute encephalopathy in the ICU poses significant diagnostic, therapeutic, and prognostic challenges. Standardized expert guidelines on acute encephalopathy are needed to improve diagnostic methods, therapeutic decisions, and prognostication.
Methods: The experts conducted a review of the literature, analysed it according to the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) methodology and made proposals for guidelines, which were rated by other experts. Only expert opinions with strong agreement were selected.
Results: The synthesis of expert work and the application of the GRADE method resulted in 39 recommendations. Among the 39 formalized recommendations, 1 had a high level of evidence (GRADE 1 +) and 10 had a low level of evidence (GRADE 2 + or 2-). These recommendations describe indication for ICU admission, use of clinical scores and EEG for diagnosis, detection of complications, and prognostication. The remaining 28 recommendations were based on expert consensus. These recomandations describe common indications for blood and CSF studies, neuroimaging, use of neuromonitoring, and provide guidelines for management in the acute phase.
Conclusion: This expert consensus statement aims to provide a structured framework to enhance the consistency and quality of care for ICU patients presenting with acute encephalopathy. By integrating high-quality evidence with expert opinion, it offers a pragmatic approach to addressing the complex nature of acute encephalopathy in the ICU, promoting best practices in patient care and facilitating future research in the field.
急性脑病在ICU提出了显著的诊断，治疗和预后的挑战。需要制定标准化的急性脑病专家指南，以改进诊断方法、治疗决策和预后。方法：专家对文献进行综述，按照GRADE （Grading of Recommendation, Assessment, Development and Evaluation）方法进行分析，并提出指导意见，由其他专家进行评分。只选择了具有强烈一致性的专家意见。结果：综合专家工作和应用GRADE方法得到39条建议。在39项正式建议中，1项具有高水平证据（1 +级），10项具有低水平证据（2 +级或2-级）。这些建议描述了ICU入院的指征、临床评分和脑电图诊断的使用、并发症的发现和预后。其余28项建议是根据专家共识提出的。这些建议描述了血液和脑脊液检查的常见适应症，神经影像学，神经监测的使用，并提供了急性期治疗指南。结论：本专家共识声明旨在提供一个结构化的框架，以提高急性脑病ICU患者的一致性和护理质量。通过整合高质量的证据和专家意见，它提供了一种务实的方法来解决ICU急性脑病的复杂性，促进患者护理的最佳实践，并促进该领域未来的研究。
期刊介绍：
Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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