终身疗程和子专业缓解护理对机械循环支持儿童的参与:来自美国的五中心回顾性队列研究,2015-2020年
Zasha Vazquez Colon1, Lorelei Robinson2, Dalia Lopez-Colon1
1Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, FL.
概括
儿科机械循环支持 (MCS) 终身护理中的子专业息护理 (SPC) 的参与率很低,早期咨询与更先进的护理计划和更少的心肺复苏有关.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 关键护理医学 关键护理医学
- 抚慰性护理是一种缓解性护理.
背景情况:
- 机械循环支持 (MCS) 越来越多地用于患有心脏病的儿童.
- 在这个人群中,终身护理 (EOL) 带来了独特的挑战.
- 了解子专业息护理 (SPC) 的作用对于优化EOL结果至关重要.
研究的目的:
- 在MCS (心室辅助器件[VADs]和体外膜氧化器[ECMO]) 上患有心脏病的儿科患者中,描述EOL护理和SPC参与.
- 检查SPC咨询的时间及其对EOL护理实践的影响.
主要方法:
- 2015-2020年接受MCS的患有心脏病的儿童 (18岁以下) 的多中心回顾性研究.
- 收集关于临床特征,SPC参与和EOL情况的数据.
- 分析SPC咨询时间及其与预先护理计划 (ACP) 和心肺复苏 (CPR) 的关联.
主要成果:
- 在MCS (23 VAD, 146 ECMO) 的838名患者中发生了169例死亡.
- 大多数死亡发生在ICU中MCS停止治疗后不久.
- 在43%的案件中,SPC参与其中,在21%的案件中,早期咨询.
- SPC参与与增加的ACP (OR 2.0) 和降低的CPR (OR 0.35) 相关.
结论:
- 在MCS后的儿科死亡往往发生在设备在重症监护中停止使用后迅速.
- SPC参与度低于最佳水平,早期咨询有限.
- 早期的SPC咨询与改善的ACP和减少的CPR有关,强调了其在目标一致的EOL护理中的好处.
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