医院前的败血症预警是否会减少完成CMS败血症测量时间?
Ruben Troncoso1, Eric M Garfinkel1, Jeremiah S Hinson1
1Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, United States of America.
The American journal of emergency medicine
|June 24, 2023
概括
医院前的败血症预警并没有显著减少完成所有四个核心败血症测量时间. 然而,警报确实加速了乳酸收集,血液培养和静脉注射液,但不是抗生素的管理.
科学领域:
- 紧急医疗 紧急医疗
- 关键护理医学 关键护理医学
- 公共卫生 公共卫生
背景情况:
- 由医疗保险和医疗补助服务中心 (CMS) 建立的败血症管理包对于改善患者的治疗结果至关重要.
- 这些包装包括及时采集血培养物,测量血清乳酸,静脉注射液体和广泛的抗生素启动.
- 医院前败血症预警协议对这些核心措施完成时间的影响仍未得到充分研究.
研究的目的:
- 评估医院前败血症预警协议在减少完成CMS败血症核心措施的时间方面的有效性.
- 为了比较患有和没有医院前败血症警报的患者之间的个人败血症核心测量完成的时间.
主要方法:
- 在2018年12月1日至2019年12月1日期间,进行了一项回顾性队列研究,涉及紧急医疗服务 (EMS) 运输的患者.
- 符合马里兰州全州EMS败血症协议标准的患者根据是否激活了医院前败血症警报进行了比较.
- 协议标准包括感染的怀疑和至少两种特定的生命体征或乳酸水平异常.
主要成果:
- 在警报 (103分钟) 和非警报 (106.5分钟) 组之间,实现所有四个CMS败血症核心措施的中位时间没有显著差异 (p=0.105).
- 在警报组中,血清乳酸采集 (28 vs. 35分钟,p=0.019),血培采集 (28 vs. 38分钟,p<0.01),以及静脉输液 (54 vs. 61分钟,p=0.025) 的中位时间显著缩短.
- 两组之间服用抗生素的中位时间没有显著差异 (94分钟对103分钟,p=0.12).
结论:
- 这项研究表明,目前的医院前败血症预警协议可能不会显著减少完成所有CMS败血症核心措施的总体时间.
- 虽然警报加速了某些成分,如乳酸和血液培养,但抗生素的施用时间没有显著影响.
- 未来的研究应该探索干预措施,例如使EMS提供者能够独立地服用抗生素,以进一步缩短败血症护理时间.
相关概念视频
01:30Acute Coronary Syndrome III: Diagnostic Studies
11
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
11
01:30Acute Coronary Syndrome I: Introduction
33
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
33
01:26Urine Studies II: Urine Culture and Sensitivity Test
58
A urine culture and sensitivity test is a diagnostic procedure used to identify urinary tract bacterial infections and determine the most effective antibiotics for treatment. This test is generally preferred when a patient shows manifestations of a urinary tract infection, such as frequent or painful urination, cloudy or foul-smelling urine, or lower abdominal pain.Purpose of the TestThe primary goals of a urine culture and sensitivity test are to:Determine the specific bacteria causing the...
58
01:22Healthcare Associated Infections II: Preventive Measures
2.7K
Essential infection prevention measures are based on the knowledge of the infection chain, the modes of transmission in healthcare settings, and the use of the best practices in all healthcare settings. Compulsory public reporting of healthcare-associated infection rates is needed to allow individuals and the community to make informed choices regarding selecting a healthcare facility.
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
2.7K
01:28Acute Coronary Syndrome IV: Interprofessional Care
13
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
13
01:26Cardiac Catheterization IV: Nursing Management
73
Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
73