在一家大型儿童医院进行非计划性输出管的结果
Cheryl L Dominick1, Brooke N Blanke2, Emily M Simmons2
1Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. defalco@chop.edu.
Respiratory care
|January 2, 2024
概括
非计划性输出管 (UE) 在儿科ICU中很常见,具有显著的不良事件和可变的再输入管率. 需要采取干预措施来减少这些事件的发生,并提高患者的安全.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 改善医疗保健质量 改善医疗保健质量
- 患者安全 患者安全
背景情况:
- 非计划性输出管 (UE) 是无意切除内管 (ETT),可能导致不稳定,需要重新输入管.
- 质量改善举措对于识别导致UE的因素和减轻不良结果至关重要.
- 了解不同儿科重症监护室 (ICU) 的UE模式对于有针对性的干预至关重要.
研究的目的:
- 调查儿童重症监护室 (PICU),心脏重症监护室 (CICU) 和新生儿重症监护室 (NICU) 的UEs的发生,贡献因素和临床结果.
- 假设和分析这些专业儿科ICU中UE发病率和结果的差异.
- 为制定有针对性的质量改善干预措施提供信息,以最大限度地减少UE.
主要方法:
- 在一个大型学术儿童医院的PICU,CICU和NICU中对UEs进行了5年的回顾性审查 (2016年1月至2021年12月).
- 利用前数据库和电子病历,通过呼吸治疗师提取数据.
- 采用基于共识的贡献因素和不良事件的定义,确保数据的一致性.
主要成果:
- 在339名受试者中报告了408例UE,其中新生儿ICU (NICU) 占多数 (80%).
- 常见的原因包括常规护理 (18%),ETT重新接入 (16%),以及患者处理 (3.9%).
- 不良事件,如脱 (<80%在33%) 和心肌梗塞 (22.8%) 是常见的,心脏骤停在12%; 67%需要在72小时内重新灌输,因单位而异 (PICU 62%, CICU 35%, NICU 71%).
结论:
- 未计划的输出管是儿科ICU的一个重大问题,与不良事件相关,需要重新输入管.
- 在UE后72小时内重新灌输的比例很大 (<70%),并且在PICU,CICU和NICU中表现出显著的变化.
- 这些发现强调了需要针对单位的质量改进战略,以减少UE的发生率和相关并发症.
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