在流体评估过程中医生的临床行为遇到流体评估
Muhammad K Hayat Syed1, Kathryn Pendleton2, John Park3
1Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX.
Critical care explorations
|June 30, 2023
概括
医生经常因为感知到的风险和后勤挑战而跳过动态流体响应测试. 为了更广泛地采用流体治疗,需要对测试益处和患者安全的信心增加.
科学领域:
- 关键护理医学 关键护理医学
- 临床认知 临床认知
- 医疗决策 - - 医疗决策
背景情况:
- 动态流体响应测试旨在通过测量心脏输出变化来指导流体治疗.
- 临床实践往往涉及流体的管理,没有事先的响应测试.
研究的目的:
- 确定影响医生的认知过程和临床行为的因素,评估患者是否需要流体治疗.
- 了解为什么动态流体响应性测试被充分利用.
主要方法:
- 对43个面对面的结构化面试进行了专题分析.
- 在19家急症医院的重症监护室和医疗外科病房进行.
- 参与者包括重症治疗师和医院医生.
主要成果:
- 医生通常会评估患有低血压,低心率,寡尿症或乳酸水平升高的患者,并权衡液体治疗的风险和益处.
- 动态测试比静态方法使用的频率较低; 液体玻尿酸通常在没有任何测试的情况下给予.
- 动态测试的障碍包括设备不可用,时间限制和缺乏专业知识.
- 医生的决定受到他们对基线液体反应率的估计和从液体球体中感知到的伤害的影响.
结论:
- 医生合理化跳过动态测试,当感知到的伤害液体球体是低.
- 动态响应测试的更广泛采用需要医生更加相信它的好处,易用性,甚至是小量的液体的潜在危害.
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