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对于生理上困难的儿科呼吸道的高风险标准:一个多中心的观察性研究,以产生有效性证据
Preston Dean1, Gary Geis1, Erin F Hoehn2
1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
在接受输管治疗的儿科患者中确定高风险标准,可以显著降低输管周心脏骤停和死亡率. 这项多中心研究证实,这些风险因素与不良结果有关.
科学领域:
- 紧急医疗 紧急医疗
- 儿科重症监护 儿科重症监护
背景情况:
- 之前的单一中心研究已经确定了急诊室 (ED) 周管化心脏骤停的风险因素.
- 需要在更多样化,多中心患者队列中验证这些发现.
研究的目的:
- 在多中心儿科急诊室队列中验证先前识别的围管内置心脏骤停的风险因素.
- 评估高风险标准与周周输入心脏骤停,体外膜氧化 (ECMO) 管道和住院死亡率之间的关联.
主要方法:
- 在8个学术儿科ED中,对1200名接受气管输管治疗的儿科患者进行了回顾性队列研究.
- 检查了六个高风险标准:持续的低血,持续的低血压,心脏功能障碍的担忧,自发循环的回归后 (ROSC),严重的代谢性酸性疾病和喘状态.
- 使用通用线性混合模型来比较符合一个或多个高风险标准的患者与没有的患者之间的结果.
主要成果:
- 27.7%的患者至少符合一个高风险标准.
- 满足任何高风险标准与显著增加周管内置停止 (AOR 75.7),ECMO (AOR 7.1) 和死亡率 (AOR 3.4) 的几率有关.
- 持续的低氧化,持续的低血压,心脏功能障碍的担忧和后ROSC独立地与周周输液停止相关.
结论:
- 满足至少一个高风险标准与儿科患者的周周输入心脏骤停有很强的关联.
- 这些发现证实了这些风险因素在更广泛的多中心环境中的预测价值.
- 识别和管理这些高风险标准可能会减轻儿科输管治疗期间的不良结果.
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