在美国住院的成年患者中,急性喘恶化的实践模式. 重症监护病房的重症监护病房是重症监护病房
Collin Homer-Bouthiette1, Burton H Shen1, Aaron C Dobie1
1Pulmonary Center, Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts.
Annals of the American Thoracic Society
|June 27, 2024
概括
在美国的重症监护病房 (ICU) 中,严重喘恶化的辅助治疗方法各不相同. 偏好非侵入性通风的医院比偏好侵入性通风的医院显示出更好的患者结果.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 严重的喘恶化需要进入重症监护室 (ICU),指导方针建议使用全身皮质类固醇和吸入β-激动剂.
- 除了ICU的第一线治疗之外的额外治疗的作用和有效性仍然不清楚.
- 了解辅助干预的实践变化对于改善患者护理至关重要.
研究的目的:
- 调查美国ICU中用于严重喘恶化症的辅助干预使用模式.
- 分析这些辅助干预措施与患者结果之间的关联.
- 根据干预概况确定医院实践集群.
主要方法:
- 利用PINC人工智能医疗数据库 (2016-2022) 进行多中心研究.
- 包括因急性喘恶化而入院美国ICU的成年患者.
- 采用层次化的通用线性模型和K-means集群来分析干预使用,变化和与结果的关联.
主要成果:
- 从961家医院鉴定了62,392名患者;在氧,吸入类固醇和机械通风策略中观察到医院间显著的变化.
- 两个不同的医院集群出现了:一个偏爱非侵入性通风 (NIV),另一个偏爱侵入性机械通风 (IMV).
- 与IMV占主导地位的集群 (集群2) 相比,NIV占主导地位的集群 (集群1) 中的医院显示出更好的结果,包括更多的不入院日和更低的住院死亡率.
结论:
- 对严重喘恶化进行辅助干预的使用在美国医院之间非常可变,围绕NIV或IMV策略进行集群.
- 有利于非侵入性通风的实践模式与改善的患者结果有关.
- 结果可以为比较有效性研究和在严重喘管理中的标准化努力提供信息.
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