捆绑护理以减少败血症死亡率:改善儿科败血症结果 (IPSO) 协作
Raina Paul1, Matthew Niedner2, Ruth Riggs3
1Division of Emergency Medicine, Children's Hospital of Orange County, University of California Irvine, Orange California.
Pediatrics
|July 12, 2023
概括
在儿童中修改过的败血症护理包,允许更多的时间用于液体和抗生素,显著减少了与败血症相关的死亡. 这种方法在改善儿科败血症结果方面,比原来的更严格的捆绑方法更有效.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 质量改善举措 质量改善举措
- 败血症的管理管理.
背景情况:
- 败血症护理包对于改善儿科患者的治疗结果至关重要.
- 之前的指导方针强调了非常快速的干预,这可能会在现实应用中带来挑战.
- 优化败血症护理要素的时间是减少死亡率的关键.
研究的目的:
- 为了提高儿科败血症护理包的利用率.
- 为了降低3日和30日败血症导致的死亡率.
- 确定与改善患者结果相关的特定护理包元素.
主要方法:
- 从2017年1月到2020年3月,一项质量改善合作 (改善儿科败血症结果),涉及40家儿童医院.
- 对两个队列的分析:IPSO疑似败血症 (ISS) 和IPSO严重败血症 (ICS).
- 对比原始捆绑 (识别,液体<20分钟,抗生素<60分钟) 与修改后的,时间自由化的捆绑 (识别,液体<60分钟,抗生素<180分钟).
主要成果:
- 分析了超过24,518个ISS和12,821个ICS病例.
- 修改的捆绑合规性随着时间的推移在两个队列中都增加了.
- 在ISS队列中,30天死亡率下降了35.7% (1.4%至0.9%).
- 在ICS队列中,修改后的包裹与30天死亡率显著降低 (4.75%至2.4%),与原始包裹不同.
结论:
- 及时治疗败血症对于减少儿科死亡率至关重要.
- 与更严格的原始包裹相比,时间自由化的败血症护理包裹在减少败血症导致的死亡率方面表现出更大的有效性.
- 这些发现支持在儿科环境中采用修改后的,基于证据的败血症护理包.
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