对于感染性休克患者的皮质类固醇处方实践的变化
Kanupriya Soni1, John S Minturn2, Billie S Davis2
1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
Critical care explorations
|February 21, 2025
概括
在ICU和医生层面上,对于败血症休克的皮质类固醇使用存在差异. 需要多层次的干预措施来标准化对性休克患者的基于证据的护理.
科学领域:
- 关键护理医学 关键护理医学
- 临床药理学 临床药理学
- 医疗服务研究 医疗服务研究
背景情况:
- 基于证据的指导方针建议在血管压缩剂依赖的败血症休克中使用皮质类固醇.
- 临床实践的变化可能会影响患者的治疗结果和医疗保健成本.
- 了解变化的来源是改善急性护理中证据吸收的关键.
研究的目的:
- 描述医生级和ICU级对有败血性休克患者的皮质类固醇处方的变化.
- 在败血症休克患者中识别与皮质类固醇使用相关的因素.
主要方法:
- 在一个多医院系统的26个ICU中,对5322名感染性休克患者进行了回顾性队列研究 (2018-2020年).
- 使用电子健康记录数据来识别在血管压缩剂开始后2天内服用皮质类固醇.
- 采用分层混合效应物流回归来量化医生和ICU之间的变化.
主要成果:
- 24.3%的患者接受了皮质类固醇. 中位数ICU水平使用率为21.8%;中位数医生水平使用率为22.0%.
- 强化护理水平的变化占皮质类固醇管理中的差异的16.5%.
- 在控制患者和医生特征后,医生级别的变化占差异的10.1%.
结论:
- 无论是ICU还是个别医生,都对治疗败血症休克时使用皮质类固醇的差异有显著的贡献.
- 针对机构和个人医生实践的多层次干预措施是必要的,以标准化基于证据的护理.
- 解决实践变化的问题可以加强对败血症冲击管理指南的一致应用.
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