呼吸治疗师驱动的机械通风协议与增加的肺部保护性通风有关
Alaina C Berg1, Erin Evans2, Uche E Okoro3
1University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa alaina-berg@uiowa.edu.
一个由呼吸治疗师驱动的协议改善了对肺部保护性机械通风的坚持,显著减少了急性呼吸困扰综合征 (ARDS) 在ICU中的发生率. 这种方法可以提高重症监护期间的患者安全.
科学领域:
- 关键护理医学 关键护理医学
- 肺部医学 肺部医学
- 呼吸系统疗法 呼吸系统疗法
背景情况:
- 机械通风是必不可少的,但具有ARDS和氧毒性等风险.
- 不遵守肺部防护通风指南是一个重大的临床挑战.
- 制定改善坚持的策略对于患者的治疗结果至关重要.
研究的目的:
- 为了评估呼吸治疗师驱动的机械通风束的影响.
- 确定该协议是否增加了对肺保护通风的坚持.
- 评估对ICU中肺部并发症率的影响.
主要方法:
- 从2018年8月1日开始,在成年ICU中实施呼吸治疗师驱动的协议.
- 协议的重点是低潮水量,足够的PEEP,有限的氧气,适当的呼吸频率和头部升高.
- 从2011年1月到2019年12月,对通风患者 (≥24小时) 的坚持和临床结果进行了回顾性分析.
主要成果:
- 干预后对肺部保护性通风的坚持显著增加 (aOR 2.48).
- 在干预后组中,急性呼吸困扰综合征 (ARDS) 的发生率降低 (aOR 0.22).
- 没有观察到VAP,无呼吸器日或ICU/30天死亡率的显著差异.
结论:
- 一个由呼吸治疗师驱动的协议有效地提高了对肺部保护性机械通风的坚持.
- 该方案与ICU患者中ARDS发病率的显著下降有关.
- 这种干预是改善机械通风安全的有价值策略.
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