通过减少高流量鼻管在呼吸系统疾病中的持续时间来改善逗留时间
Brittany M Hunter1,2, Cynthia Castiglioni1,2,3, Abigail B Nellis3
1Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois.
实施质量改进的断奶算法显著减少了儿童呼吸系统疾病的高流鼻腔管 (HFNC) 治疗和住院时间. 这种方法优化了支气管炎,肺炎和喘患者的护理.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 呼吸系统疗法 呼吸系统疗法
- 质量改进科学 质量改进科学
背景情况:
- 高流量鼻腔管 (HFNC) 的使用在急性呼吸道疾病中正在增加,尽管对普遍应用的证据有限.
- 优化HFNC治疗持续时间对于改善患者的治疗结果和资源利用是至关重要的.
研究的目的:
- 在患有支气管炎,肺炎或喘的儿科患者 (1个月至5年) 中,将HFNC治疗时间 (LOT) 和停留时间 (LOS) 减少10%.
- 通过使用标准化的断奶算法实施和评估质量改进 (QI) 计划.
主要方法:
- 一个多学科的团队应用了QI方法来实现HFNC断药的快速断奶算法.
- 该算法专注于基于重量的流速,并使用运行图表和统计过程控制来监控.
- 主要结局是LOT和LOS;平衡措施包括再接收率和正压通风 (PPV) 的使用.
主要成果:
- 平均LOT下降了29% (55.7至39.7小时),平均LOS下降了25% (94.3至70.6小时).
- 高铁断流量增加 (0.6至0.9升/公斤/分钟),快速断奶 ("假日") 事件显著增加 (10.9%至82.8%).
- 改进表明了统计过程控制,PPV的使用和再录取仍然很低.
结论:
- 在患有常见呼吸道疾病的儿科患者中,QI方法有效降低了HFNC LOT和LOS.
- 实施的断奶算法促进了HFNC的快速停止,从而大大提高了治疗效率.
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