在患有创伤性肋骨骨折的患者中实施修改的疼痛,灵感和咳方案
Elysa Margiotta1, Isaac E Wenger1, Jonathan Henglein1
1Department of Surgery, Northwell, New Hyde Park, New York; Department of Surgery at Zucker School of Medicine, Manhasset, New York.
The Journal of surgical research
|December 31, 2024
概括
实施修改的疼痛,灵感,咳 (mPIC) 协议显著降低了创伤性肋骨骨折患者的输管率和住院时间. 早期动员和多模式止痛进一步改善了结果.
科学领域:
- 创伤外科手术是什么
- 关键护理医学 关键护理医学
- 肺部并发症 肺部并发症
背景情况:
- 粗的胸壁损伤和肋骨骨折往往导致严重的肺部并发症,如,肺炎和ARDS.
- 这些并发症可能需要机械通风,导致与疼痛有关的脱水,并延长住院时间.
- 现有的文献包括分拣算法和机构协议,以管理创伤性肋骨骨折和减少并发症.
研究的目的:
- 评估修改的疼痛,灵感,咳 (mPIC) 协议对创伤性肋骨骨折患者的住院并发症的影响.
- 评估输管率的变化,停留时间的长度,以及协议实施前后的其他疾病.
主要方法:
- 从2019-2022年对820名患有创伤性肋骨骨折的患者进行了回顾性审查.
- 收集的数据包括人口统计,mPIC分数,疼痛管理策略 (包括神经阻塞),输管率和早期动员.
- 进行统计分析以确定显著性 (P <0.05).
主要成果:
- 该mPIC协议显著降低了输管率,从18.2%降至3.0% (P<0.001).
- 伤害严重性评分 (ISS) >25的患者显示,在治疗后输内管的可能性降低 (65.0%对比16.7%,P<0.001).
- 整体住院时间 (LOS) 从5天减少到4天 (P < 0.001),早期动员也与减少的LOS相关.
结论:
- 一个标准化的mPIC协议有效地降低了创伤性肋骨骨折患者的输管率和医院LOS.
- 多模式止痛和早期动员是促进改善结果的关键组成部分.
- 实施mPIC协议可以减轻与创伤性肋骨骨折相关的潜在疾病.
相关概念视频
01:26Flail 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
01:27Pneumothorax-II
120
Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
Clinical Manifestations:
120
01:24Flail Chest-I
139
Overview of Flail Chest
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
139
01:29Acute Respiratory Failure-V
123
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
123
01:24Chest Physiotherapy
378
Chest Physiotherapy (CPT) is a therapeutic technique used in respiratory care to improve ventilation, clear bronchial secretions, and enhance the efficiency of respiratory muscles. This therapy includes three primary procedures: postural drainage, percussion, and vibration. It can be performed on spontaneously breathing patients and those who are intubated and mechanically ventilated.
Purpose
CPT is primarily used for patients with excessive bronchial secretions who have difficulty clearing...
Purpose
CPT is primarily used for patients with excessive bronchial secretions who have difficulty clearing...
378
01:23Acute Respiratory Failure-IV
125
Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...
125