息治疗转诊模式和对心脏ICU标准化的影响
Arshia Madni1,2, Jocelyn Matheson1, Amanda Linz1,2
1University of Tennessee Health Sciences Center, Memphis, TN, USA.
Pediatric cardiology
|October 21, 2024
概括
儿科息护理 (PPC) 的参与在儿科心脏重症监护病房中很常见,但往往发生迟. 较早的PPC转诊和标准化识别可以改善重症儿童的护理.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 抚慰性护理医学 抚慰性护理医学
- 密集护理医学 密集护理医学
背景情况:
- 儿科息治疗 (PPC) 被认为对医疗复杂的儿童有益.
- 从历史上看,PPC参与一直不一致,在儿科重症监护机构中经常延迟.
- 由于心血管重症监护室 (CVICU) 中对PPC的认识增加,因此需要对其在临终患者中的使用进行调查.
研究的目的:
- 调查在ICU中死亡的儿科患者的PPC转诊的频率和及时性.
- 检查PPC与不复苏 (DNR) 讨论和死亡当天的心肺复苏 (CPR) (DOD) 之间的关联.
主要方法:
- 在5年的时间里,对在ICU中死亡的儿科心脏病患者进行回顾性研究.
- 收集的数据包括PPC存在和时间,干预,治疗,CPR状态和DNR讨论.
- 分析对PPC参与和不参与的患者的结果进行了比较.
主要成果:
- 在ICU死亡的儿科心脏病患者中,PPC参与发生在74% (40/54) 的儿科心脏病患者中.
- 在没有PPC的患者中,79%的患者符合基于既定指南的PPC转诊标准.
- PPC患者在DOD和DOD之前都更有可能进行DNR讨论 (63%对14%,p=0.0011).
- PPC参与并没有显著影响DOD上CPR的可能性 (28%对43%,p=0.29).
- 最初的PPC通常发生在一周内或死亡当天.
结论:
- 医疗保险公司经常参与在CVICU死亡的儿科患者的护理.
- PPC转诊的及时性往往低于最佳,许多患者有资格接受早期干预.
- 标准化PPC的患者识别,时间和转诊流程可以提高其在CVICU中的有效性.
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