确定在重症儿童中优化流体平衡的机会
medRxiv : the preprint server for health sciences
|January 27, 2025
概括
流体过载在儿科重症监护室 (PICU) 中很常见,在不同设施的不同率. 解决特定地点的液体平衡驱动因素对于有效的管理和改善患者结果至关重要.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 流体管理流体管理
背景情况:
- 流体过载 (FO) 是儿科重症监护室 (PICU) 的一个重要并发症,与增加的发病率和死亡率有关.
- 由于独特的机构需求,障碍和局限性,准确的流体平衡 (FB) 报告和管理具有挑战性.
研究的目的:
- 在PICU入院的最初几天内调查累积流体平衡 (CFB) 阳性的流行情况.
- 确定积极CFB的特定地点驱动因素,准确FB记录的障碍,以及改进的机会.
主要方法:
- 一项同时进行的混合方法研究,结合了四个三级儿科重症监护室的回顾性观察数据和前性采访/调查.
- 使用联合数据收集框架从电子健康记录中提取的液体平衡数据.
- 主要结果:在PICU第1天和第2天的%CFB,计算为 (总摄入量 - 总输出量) / PICU入院重量.
主要成果:
- 第二天CFB>5%在不同地点的39%至54% (p=0.03) 和>10%在16%至25% (p=0.04) 之间.
- 在尿液输出记录和液体管理协议中观察到显著的位置间变化 (p<0.001).
- 虽然FB目标的讨论频率各不相同,但报告的障碍和改进机会在各个网站上都是相似的.
结论:
- 积极的液体平衡在PICU患者中普遍存在,其比例在不同ICU中具有显著的变化.
- 有效的FO管理需要在每个小儿重症监护病房针对正流体平衡的独特驱动因素.
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