使用术后因素预测术后病人的病情恶化和意想不到的重症监护病房入院情况
Eveline H J Mestrom1, Tom H G F Bakkes2, Nassim Ourahou1
1Anesthesiology Department, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
PloS one
|August 3, 2023
概括
预测计划外的重症监护病房 (ICU) 入院对于患者护理至关重要. 结合手术前,手术期间和手术后的因素,可显著改善ICU入院预测,有助于更好地分配患者. 关键词:ICU入院预测,患者分配,手术后护理.
科学领域:
- 麻醉学 麻醉学
- 临界护理医学 临界护理医学
- 医疗信息学 医疗信息学
背景情况:
- 缺乏基于证据的标准,用于麻醉后护理单位 (PACU) 的决策.
- 需要改善将患者分配到适当的护理水平.
- 有潜力减少意想不到的重症监护室 (ICU) 住院,并改善患者的治疗结果.
研究的目的:
- 评估是否包括手术前和手术后的因素可以改善患者病情恶化的预测.
- 为了评估预测不可预期的ICU入院的预测.
- 为PACU患者分配提供临床决策支持工具的开发提供信息.
主要方法:
- 追溯观察队列研究 (2013年1月 - 2017年12月).
- 荷兰的第三级医院环境.
- 排除标准:心胸外科,产科,托儿所和儿科手术等.
- 主要结局:意外进入ICU.
主要成果:
- 0.9%的患者 (223) 经历了意想不到的ICU入院,死亡率更高 (13.9%vs0.2%).
- 确定了关键预测因素:年龄,BMI,麻醉类型,手术前得分,糖尿病,血管压缩剂的使用,红细胞的使用,手术的持续时间,PACU停留,心率和氧和.
- 模型实现了0.86的曲线下的面积,用于预测ICU入院.
结论:
- 结合手术前,手术期间和手术后早期的因素,可以提高预期不到的ICU入院的预测能力.
- 电子医疗记录数据集成对于预测建模是有效的.
- 强调需要在PACU中采用临床决策支持系统,以优化患者管理和分配.
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