在重大创伤性脑损伤中使用正压通风的EMS治疗指南
Joshua B Gaither1,2, Daniel W Spaite1,2, Bentley J Bobrow3
1Arizona Emergency Medicine Research Center, College of Medicine-Phoenix, The University of Arizona, Phoenix.
JAMA surgery
|January 24, 2024
概括
实施医院前创伤性脑损伤 (TBI) 准则改善了接受正压通风 (PPV) 的严重TBI患者的生存率. 这些发现支持当前针对严重TBI护理的积极气道管理的建议.
科学领域:
- 紧急医疗 紧急医疗
- 神经外科 神经外科
- 关键护理医学 关键护理医学
背景情况:
- 医院前伤害护理卓越 (EPIC) 研究显示,在实施指南后,严重创伤性脑损伤 (TBI) 患者的生存率有所改善.
- 这些指南对接受正压通风 (PPV) 的患者的影响以前是未知的.
研究的目的:
- 评估医院前TBI基于证据的指南实施与生存率之间的关联.
- 专注于接受医院前PPV的患者.
主要方法:
- 使用前/后受控设计,对EPIC研究进行了次分析.
- 包括接受了医院前PPV的患者,比较了实施前和实施后的队列.
- 后勤回归被用于结果比较,按TBI严重程度分层.
主要成果:
- 住院后的总体生存率有所改善 (aOR,1.59),但出院后的生存率没有显著变化.
- 在接受PPV的严重TBI患者中,存活到入院 (aOR,6.44) 和出院 (aOR,3.52) 的时间显著增加.
- 这些好处观察到,无论呼吸道干预类型 (基本或高级).
结论:
- 医院前指导方针的实施独立地与接受PPV的严重TBI患者的生存率改善有关.
- 支持当前的指导方针,建议在严重的TBI中积极管理缺氧和高通风.
- 这些发现与医院前TBI护理中的基本和高级气道干预都有关.
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