儿童心脏骤停后的有针对性的温度管理:在 PICU 中进行多学科实施的质量改善计划
Mason P McMullin1,2, Noelle B Cadotte3, Erin M Fuchs4
1Department of Pediatrics, Uniformed Services University, Bethesda, MD.
概括
实施一个有针对性的温度管理 (TTM) 包,显著减少了儿科心脏骤停幸存者的发烧持续时间. 这项质量改善计划通过将心脏骤停后发烧时间降至最低来改善患者的治疗结果.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 提高质量 提高科学 提高质量
- 心血管研究研究心血管研究
背景情况:
- 心脏骤停后发烧与儿科患者的神经结果的恶化有关.
- 有效的发烧管理对于改善心脏骤停后的生存和恢复至关重要.
- 目前的目标温度管理 (TTM) 协议需要针对儿科患者进行优化.
研究的目的:
- 在儿科重症监护室 (PICU) 实施全面的TTM包.
- 为了减少心脏骤停后患者发烧 (温度高于38°C) 的百分比.
- 目标是将发烧时间从7%减少到3.5%.
主要方法:
- 在16个月内 (2021年4月至2022年6月) 进行了前性质量改进计划.
- 实施了一套TTM包,包括标准化的温度目标,冷却毯协议,预定的抗热药和管理.
- 来自29名干预前历史对照患者的数据与46名干预期患者的数据进行了比较.
主要成果:
- 每位患者发烧时间的中位数百分比从7% (IQR,0-13%) 降至0% (IQR,0-3%) (p < 0.001).
- 在干预期内,在任何时候出现发烧的患者较少 (16/46比21/29;减少37%,p=0.002).
- 在干预和低温症 (<35°C) 的发展之间没有发现显著的关联.
结论:
- 实施TTM捆绑有效地减少了儿科心脏骤停幸存者的发烧持续时间和频率.
- 这项质量改进项目证明了TTM捆绑在PICU环境中的成功应用.
- TTM捆绑是改善儿科患者心脏骤停后护理的一个有价值的策略.
相关概念视频
Decreased Body Temperature
602
A decreased body temperature can occur in patients with hypothermia and frostbite. Heat loss with extended cold exposure overpowers the body's ability to create heat, resulting in hypothermia. Core temperature readings help classify hypothermia. Mild hypothermia is temperatures between 32 °C (89.6 °F) and 35°C (95 °F) and is caused by impaired thermoregulation. Moderate hypothermia is temperatures between 28 C (82.4 °F) and 32 °C (89.6 °F) caused by...
602
Methods of reducing fever
643
The signs and symptoms of fever include hot and dry skin, flushed face, thirst, muscle aches, anorexia, headache, tachycardia, tachypnea, and fatigue. Elevated body temperature is reduced using two methods: pharmacological and nonpharmacological. Proper identification and treatment of the root cause of a fever is of utmost importance.
Pharmacological Methods of Reducing Fever:
Pharmacological Methods of Reducing Fever:
643
Flail Chest-II
160
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
160


