美国手术期间氧气管理的决定因素和实践变化:一项回顾性队列研究
Frederic T Billings1, David R McIlroy1, Matthew S Shotwell2
1Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Anesthesiology
|May 17, 2024
概括
在手术期间补充氧气的使用有很大的差异,医疗中心和麻醉提供者解释了更多的变化,而不是患者或手术因素. 最佳的方法仍然不清楚,这表明氧气输送中的任意做法.
科学领域:
- 麻醉学 麻醉学
- 在外科手术期间的医学.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在手术期间最佳的补充氧气管理还不清楚,导致实践变化.
- 了解氧气使用的决定因素对于标准化护理至关重要.
研究的目的:
- 为了评估患者,手术,医疗中心和麻醉提供者与手术内氧气管理变异性相关的因素.
- 确定手术过程中补充氧气使用差异的关键驱动因素.
主要方法:
- 对367,841例手术病例的多变量线性混合效应回归分析.
- 2016年1月至2019年1月期间,从42个美国医疗中心收集的数据.
- 分析的重点是成年患者接受全身麻醉和气管管道输入术的手术至少持续120分钟.
主要成果:
- 吸入氧气的中位数分数为0.55;6.9%的病例接受了<0.40,8.7%的病例接受了>0.90.
- 患者和程序因素解释了最小的变化 (分别为3.5%和4.4%).
- 医疗中心 (23.3%) 和麻醉提供者 (麻醉师7.7%,室内提供者8.1%) 解释了大量的变化,其中53%是无法解释的.
结论:
- 在成年人中,手术内补充氧气的使用是高度可变的,看起来是任意的.
- 医疗中心和麻醉提供者因素显著影响氧气的管理,而不是患者或程序的特点.
- 需要进一步的研究,以建立基于证据的指导方针,以在手术期间最佳使用氧气.
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