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紧急部门的有效性和安全性代码败血症协议:一个务实的临床试验

Ithan D Peltan^1,2, Joseph R Bledsoe³, Jason R Jacobs¹

¹Department of Pulmonary & Critical Care Medicine.

Annals of the American Thoracic Society

|July 12, 2024

概括

实施"代码败血症"减少了败血症患者在急诊室 (ED) 门到抗菌剂的时间. 然而,这种败血症协议也导致了抗菌药物的使用增加和错误的阳性诊断.

科学领域:

紧急医疗紧急医疗
传染性疾病传染性疾病
改善医疗保健质量改善医疗保健质量

背景情况:

败血症护理,特别是及时的抗菌药物管理,仍然是急诊室 (ED) 的一个挑战.
低于最佳的败血症护理需要进行干预,以改善患者的治疗结果.

研究的目的:

评估重组急诊室 (ED) 败血症护理的直接和非目标影响.
评估基于团队的多式联络"Code Sepsis"协议对败血症管理的影响.

主要方法:

一个务实的试点试验,比较一个ED中的"Code Sepsis"协议实施与两个对照ED中的常规护理.
在协议实施之前和之后 (2019年11月-2021年2月) 分析了呈现败血症标准 (败血症-3) 的成年患者.
主要结局:门到抗菌剂的时间;次要结局:30天死亡率,抗菌剂的使用和不良事件.

主要成果:

"代码败血症"协议显示8.5%的敏感性和66%的败血症的积极预测值.
实施与13分钟的门到抗微生物药物的时间显著减少有关 (P < 0.001).
没有观察到死亡率或安全性结果的变化,但抗菌药物的使用和错误的阳性诊断增加.

结论:

在最初的COVID-19流行年",Code Sepsis"协议成功地减少了ED门到抗菌药的时间.
该干预措施还导致了抗微生物药物使用的增加和感染诊断的增加.
对败血症护理干预措施的全面评估需要评估以患者为中心和非目标效应.

关键词:

抗生素时间抗生素时间紧急医疗紧急医疗医疗保健服务医疗保健服务这是一种血症.

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