儿童心脏病重症监护室的呼吸机释放实践
Amy J Romer1, Samer Abu-Sultaneh2, Michael G Gaies3
1Dr. Romer is affiliated with Division of Cardiac Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
Respiratory care
|March 3, 2025
概括
对心脏病重症儿童的呼吸机释放实践缺乏标准化的协议. 这项研究揭示了输出管准备测试和输出管后支持的显著差异,突出了需要改进的指导方针和质量改进举措的需要.
科学领域:
- 儿科重症监护中心儿童重症监护中心
- 心脏病学 心脏病学
- 呼吸系统医学 呼吸系统医学
背景情况:
- 机械通风在患有心脏病的重症儿童中很普遍.
- 有限的文献存在于这个特定的儿科群体的呼吸机释放实践.
- 了解当前的做法对于改善患者的治疗结果至关重要.
研究的目的:
- 描述当前心脏病重症儿童的呼吸机释放实践.
- 为了识别输出管的准备测试和输出管后支持的变化.
- 突出协议开发和质量改进的领域.
主要方法:
- 电子调查分发给儿科重症监护室的医生,这是儿科心脏急症监护协会的成员.
- 该调查评估了机构协议和个人实践,涉及呼吸机释放,输出管准备测试 (ERT),自发呼吸试验 (SBT) 和输出管后支持.
- 分析了来自47家医院的133个反应.
主要成果:
- 只有47%的机构报告了ERT资格选,55%报告了SBT协议.
- 大多数受访者利用SBTs (95%) 和压力支增强到CPAP (92%) 进行输出管评估.
- 观察到的显著变化是排泄准备的参数 (例如,脉冲氧计,乳酸盐,pH,混合静脉和) 和排泄后的非侵入性呼吸辅助 (NRS) 使用.
结论:
- 在大约一半的受访机构中,缺乏标准化的ERT资格选和SBT协议.
- 输出管的准备性评估和输出管后呼吸支策略存在很大差异.
- 显然需要与临床指导方针一致的协议开发和多中心质量改进,以建立儿童心脏病患者呼吸机释放的最佳实践.
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