术后ICU要求与Fontan手术中的早期输出管的相关性
Keriann L Potter1, Marc E Richmond1, Andrew B Goldstone2
1Division of Pediatric Cardiology, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, USA.
Cardiology in the young
|July 12, 2023
概括
在Fontan手术后的早期输出管 (EE) 减少了对血管活性-无热支持 (VIS) 的需求. 然而,现代队列中的晚期输出管 (LE) 患者需要更多的静脉注射液体 (IVF),这表明需要进一步研究的高风险组.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 心脏外科手术 心脏外科手术
- 密集护理医学 密集护理医学
背景情况:
- 芬坦手术是一种复杂的手术,用于单心室先天性心脏缺陷.
- 优化术后护理,包括输出管的时间,对于患者的治疗结果至关重要.
- 了解早期输出管 (EE) 对重症监护室 (ICU) 支持的影响至关重要.
研究的目的:
- 调查早期输出管 (EE) 与Fontan手术后术后ICU支持程度之间的关联.
- 评估EE对静脉注射液 (IVF) 容量和血管活性-异位积 (VIS) 的影响.
主要方法:
- 对接受丰丹息治疗的患者 (2008-2018) 的回顾性分析.
- 对EE率的倡议前 (控制) 和倡议后 (现代) 队列的比较.
- 用ANOVA或克鲁斯卡尔-瓦利斯试验进行详细分析,分为早期 (EE) 和晚期 (LE) 的分层.
主要成果:
- 与对照组 (42.6%) 相比,现代队列中的EE率显著增加 (75.7%).
- 现代队列的VIS中位数较低,但总体IVF平均值较高.
- 现代队列中的晚期抽管 (LE) 患者表现出最高的VIS和试管婴儿需求,接受了67%以上的试管婴儿,并在24小时内获得更高的VIS中位数.
结论:
- 在Fontan手术后的早期输出管 (EE) 与手术后的血管活性-异位积分 (VIS) 降低有关.
- 现代队列中的晚期输出管 (LE) 患者代表了一个高危子组,需要更多的试管婴儿和潜在的密集监测.
- 对这种高风险的LE子组进行进一步调查是有必要的,以优化Fontan的患者护理.
相关概念视频
01:24Endotracheal Tube Extubation
886
Endotracheal tube extubation is a critical procedure in weaning patients from mechanical ventilation. It involves physically removing the oral or nasal endotracheal (ET) tube, marking the final step in liberating a patient from ventilatory support.
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
886
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
16
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
16
01:17Endotracheal Intubation II: Nursing Management
817
Endotracheal intubation is a critical procedure that can be lifesaving for many patients with respiratory distress or failure. The role of nursing in managing endotracheal tubes is pivotal, as it involves pre-intubation preparation, assisting during the procedure, and post-extubation care.
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
817
01:15Endotracheal Intubation I: Procedure
1.8K
Endotracheal or ET intubation is a critical medical procedure used to secure a patient's airway, often in acute respiratory distress, apnea, upper airway obstruction, ineffective clearance of secretions, high risk for aspiration, or during general anesthesia.
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
1.8K
01:21Tracheostomy Decannulation
243
Tracheostomy decannulation is a significant milestone in the liberation of mechanically ventilated patients. Despite its importance, there is no universally accepted protocol for this procedure. This demands an evidence-based, individualized approach.
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
243
01:23Peripheral Artery Disease V: Postoperative Nursing Management
12
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
12