在发烧的乌干达儿童中,在急诊室注射液体后的死亡率
Brian Rice1,2, Jessica Hawkins3, Serena Nakato2,4
1Department of Emergency Medicine, Stanford University, Palo Alto, California, United States of America.
PloS one
|August 31, 2023
概括
乌干达急救部门的儿科液体复苏没有显著影响发烧儿童的死亡率. 建议个性化流体管理,而不是通用协议,以获得更好的患者结果.
科学领域:
- 儿科急救医学 儿科急救医学
- 全球健康 全球健康
- 临床试验 临床试验
背景情况:
- 撒哈拉以南非洲的儿科液体复苏传统上发生在住院患者的环境中.
- 作为支持性治疗 (FEAST) 的流体扩张试验表明,发烧性住院患者的流体栓塞增加了死亡率.
- 撒哈拉以南非洲的紧急护理扩张将液体复苏转移到急诊室.
研究的目的:
- 确定紧急病房液体复苏对乌干达发烧儿科患者的死亡影响.
- 评估在紧急情况下的液体复苏是否会与住院患者不同地影响结果.
- 在资源有限的环境中,为儿科紧急护理提供流体管理的最佳实践信息.
主要方法:
- 在乌干达紧急病房 (2012-2019) 的3087名发烧儿科患者 (2个月-12岁) 的回顾性队列研究 (2012-2019).
- 倾向性得分匹配创造了匹配的队列,以比较接受和不接受液体的患者之间的死亡率.
- 进行了后勤回归和灵敏度分析,包括对FEAST试验标准的子组分析.
主要成果:
- 整体死亡率为4.0%,在匹配或不匹配的队列中,液体复苏和非液体组之间的三天死亡率没有显著差异.
- 对FEAST标准的调整分析和灵敏度分析也显示没有显著的死亡益处或伤害.
- 该研究具有类似于FEAST的绝对危害检测功率,但缺乏检测相对风险增加的功率.
结论:
- 乌干达急诊室的液体复苏并没有显著改变发烧儿童的三天死亡率.
- 积极的或节水的通用协议可能不是最佳的;建议进行个性化液体复苏.
- 可能需要进一步的研究,以澄清不同儿科紧急病例群体的最佳流体策略.
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