药剂师驱动的药物稀释剂体积优化协议对重症患者的流体平衡和结果的影响
Michael L Behal1, Breanne M Mefford1, Chris Donaldson1
1University of Kentucky Medical Center, Lexington, KY, USA.
Hospital pharmacy
|May 20, 2024
概括
在ICU中优化药物稀释剂容量并没有显著改变患者的液体平衡. 虽然抗微生物稀释剂量的减少,但需要一个全面的方法,以有效的流体管理在重症监护.
科学领域:
- 关键护理医学 关键护理医学
- 临床药房 临床药房 临床药房
- 流体管理流体管理
背景情况:
- 在重症监护室 (ICU) 中,体积过载 (VO) 很普遍,导致患者的不良结果.
- 目前管理VO的策略缺乏专注于优化药物稀释剂量.
- 药物稀释剂在重症患者中代表了一种潜在的可修改的液体管理来源.
研究的目的:
- 评估药剂师领导的协议对优化药物稀释剂体积对ICU患者的液体平衡的影响.
- 评估本协议对液体平衡,药物给药量和临床结果的影响.
主要方法:
- 一项前性试点研究,比较医疗ICU的实施前 (控制) 和实施后 (干预) 期间.
- 实施药剂师驱动的协议,以减少血管压缩剂和抗微生物药物的稀释剂量.
- 收集人口统计,临床数据和流体平衡指标长达7天,主要关注第3天的净流体平衡.
主要成果:
- 该研究包括152名患者;前组123名,后组29名,急性呼吸衰竭是最常见的诊断.
- 虽然抗微生物稀释剂量在治疗后显著减少,但第三天的净液体平衡在各组之间没有显著差异 (2012.3毫升 vs 227.1毫升).
- 在药物量 (不包括稀释剂),ICU停留时间或死亡率方面没有发现显著差异.
结论:
- 仅仅优化药物稀释剂量,特别是针对抗菌素的药物,并没有显著改善危急病患者的净液体平衡.
- 这些发现表明,药物稀释剂优化可能是流体管理的一个组成部分,但不是唯一的解决方案.
- 未来的研究应该探索药物稀释剂优化和ICU中综合流体管理协议的综合战略.
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