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在严重疾病期间实践模式和补充值值的结果
Nicholas A Bosch1, Emily A Vail2,3, Anica C Law1
1Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
补充在重症监护室 (ICU) 很常见,通常发生在正常血清水平内. 补充的基于值的策略不会显著改变患者的结果.
科学领域:
- 关键护理医学 关键护理医学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 临床药房 临床药房
背景情况:
- 补充是重症患者经常进行的干预措施.
- 目前与各种重症监护室 (ICU) 补充策略相关的做法和结果尚不清楚.
研究的目的:
- 在成年ICU患者中界定补充实践.
- 为了比较不同补充策略的有效性.
- 评估特定补充值值对患者结果的有效性和安全性.
主要方法:
- 对PINC人工智能医疗数据库 (2016-2022) 的回顾性分析,涉及入住重症监护室的重病成年人.
- 根据补充模式对ICU进行分类:基于值或概率.
- 通过使用层次回归模型和回归不连续性分析对特定值 (3.5和4.0mEq/L) 的不同ICU类型的患者之间的结果进行了比较.
主要成果:
- 该研究包括88个ICU的190,490名患者;35.0%接受.
- 在基于值的 (33.5%) 和概率的 (36.4%) ICU 中,补充率是可比的,在调整后的风险中没有显著差异 (aOR,1.09;95% CI,0.76-1.57).
- 回归不连续性分析表明,超过3.5mEq/L或4.0mEq/L的值会使补充率增加36-39%,但不会影响其他患者的结果.
结论:
- 补充在重症患者中很普遍,经常发生在3.5-4.0mEq/L范围内.
- 在ICU采用基于值的补充策略与患者结果的临床显著变化无关.
- 目前的补充实践可能不需要根据特定的血清值进行调整.
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