在快速响应系统激活后,在恶化患者中新实施的不尝试复苏命令的发生率和相关因素:使用日本多中心数据库的回顾性观察研究
Tatsuya Tsuji1,2,3, Yoshiki Sento1, Toshiyuki Nakanishi1
1Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medical Sciences Nagoya City University Nagoya Japan.
Acute medicine & surgery
|July 7, 2023
概括
快速反应系统 (RRS) 的激活与5.6%的患者的新做不尝试复苏 (DNAR) 命令有关. 高龄,恶性瘤和较高的国家早期预警分数2预测DNAR订单.
科学领域:
- 医学科学 医学科学 医学科学
- 临床医学 临床医学
- 患者的治疗结果.
背景情况:
- 快速反应系统 (RRS) 旨在改善患者的治疗结果.
- 新出现的证据表明,RRS激活可能会影响"不要尝试复苏" (DNAR) 命令.
- 了解与RRS后的DNAR订单相关的因素对于患者护理至关重要.
研究的目的:
- 为了确定RRS激活后新的DNAR订单的发生率.
- 识别患者特征和与新DNAR订单独立相关的临床因素.
- 分析DNAR订单实施在恶化患者的预测因素.
主要方法:
- 在日本 (2012-2021) 需要RRS激活的患者的观察研究.
- 对患者人口统计,临床数据和先前存在的DNAR状态进行分析.
- 用于识别独立预测器的多变量层次逻辑回归模型.
主要成果:
- 7904名患者激活了RRS;5.6% (394/7066) 接受了新的DNAR订单.
- 新的DNAR订单与年龄较大的年龄类别显著相关 (aOR 1.56-6.58).
- 恶性病 (aOR 1.82),术后状态 (aOR 0.45) 和 NEWS2 评分 (aOR 1.07) 也是重要的预测因素.
结论:
- 在RRS激活后,大约有18名患者中的1人有新的DNAR订单.
- 影响新DNAR订单的关键因素包括晚年,恶性瘤,术后状态和NEWS2分数.
- 这些发现凸显了重症监护反应和终身护理决策之间的复杂相互作用.
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