在ARDS中坚持肺部保护性通风:一种混合方法研究,使用实时持续监控的通风数据
Joseph M Plasek1, Peter C Hou2, Wenyu Zhang1
1Drs Plasek, Ortega, Chuang, and Zhou and Ms Zhang and Mr Tan are affiliated with the Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Respiratory care
|October 29, 2024
概括
工作人员对ARDS患者肺部保护性通风指南的遵守仍然不够理想. 患者的性别和COVID-19状态等因素影响了遵守,突出显示了持续监测和反的必要性.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统疗法 呼吸系统疗法
- 机械通风机械通风机械通风
背景情况:
- 肺保护性呼吸 (LPV) 对于管理ARDS和预防呼吸器诱导的肺损伤至关重要.
- 目前对LPV指导方针的坚持是次优的,尽管其已证明的好处.
- 了解影响员工遵守的因素对于改善患者的治疗结果至关重要.
研究的目的:
- 确定影响员工遵守LPV指南的因素.
- 分析5年的实时通风数据,以评估LPV利用率.
- 探讨临床护理提供者对LPV非利用的观点.
主要方法:
- 对1055名ARDS患者 (计费代码J80) 的机械通风 (2018-2022) 的回顾性队列研究.
- 动态潮体积测量 (≤6毫升/千克预测体重) 每小时分析.
- 定性焦点小组与重症监护提供者一起探索不遵守的原因.
主要成果:
- 只有42.4%的患者在48小时后接受LPV.
- 在非COVID-19患者中,男性性别与LPV使用有关,而年龄≥60与非使用有关.
- 在COVID-19患者中,LPV使用率较高,与COVID-19诊断,男性性别和神经肌肉阻断剂使用相关;然而,癌症和高血压与LPV使用率较低有关.
结论:
- 尚未实现对LPV最佳实践的普遍遵守.
- 持续监测和频繁反临床团队是改善LPV遵守的建议策略.
- 需要精确的高度测量来确定适当的潮体积.
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