在烧伤单元的无计划输出管:回顾性审查
Cameron Nelson1, Isaac Weigel2, Colette Galet2
1University of Iowa Carver College of Medicine, Division of Acute Care Surgery, University of Iowa, Iowa City, Iowa, USA.
概括
在烧伤患者中,无计划的口可通过手术放置的咬伤块显著减少. 吸入伤害是无计划输出管的关键风险因素,突出了需要安全策略的需要.
科学领域:
- 临界护理医学 临界护理医学
- 烧伤手术 烧伤手术
- 呼吸系统疗法 呼吸系统疗法
背景情况:
- 之前报告的烧伤患者的非计划性输出率高达27% (每100个呼吸机日中有3个).
- 面部烧伤对内肌管的固定具有独特的挑战.
- 在这个烧伤中心,按医疗服务提供者的裁量来使用手术放置的咬伤块来固定管子.
研究的目的:
- 评估专业烧伤中心烧伤患者的非计划性输出管率.
- 在这个患者群体中确定与非计划性输出管相关的因素.
- 为了评估与非计划性输出管相关的呼吸机相关肺炎 (VAP) 的并发症率.
主要方法:
- 从2015年7月到2023年6月,对烧伤患者需要机械通风的回顾性队列研究.
- 收集和比较人口统计,并发病,伤害和医院疗程数据.
- 二进制物流回归分析,以确定与非计划性排泄和VAP相关的因素.
主要成果:
- 总体而言,非计划性排气率为4.7% (每100个呼吸机日0.7),与之前的报道相比显著下降.
- 没有计划的输出管的患者更有可能受到吸入伤害 (70.6%与42.6%相比),paCO2升高,呼吸机和住院时间更长.
- 在手术放置咬伤块的患者中没有发生未计划的输出;在未计划的输出组中,VAP率在数值上更高 (17.6%与5.5%相比).
结论:
- 手术放置的咬伤块似乎是一种有效的策略,用于防止烧伤患者的意外口.
- 在这个人群中,吸入伤害是无计划输出管的重要独立风险因素.
- 对于烧伤患者,建议对先进的固定装置,如咬伤块进行进一步的研究.
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