基于HACOR得分的降级处置与非侵入性通风治疗ED患者的死亡率之间的关联
Mattia Versace1, Rudy Marchetti1, Carolina Cogozzo1
1High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
由于急性呼吸衰竭而接受非侵入性通风 (NIV) 治疗的患者,如果他们的HACOR得分为2或以下,并且不完全依赖NIV,则可以安全地转移到普通病房. 这一策略减少了符合条件的患者在医院死亡率.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统医学 呼吸系统医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 急性呼吸衰竭需要非侵入性通风 (NIV) 支持,通常在高依赖性单位 (HDU) 启动.
- 确定适合从HDU转移到普通病房的患者对于优化资源配置和患者流动至关重要.
- 高依赖性急性护理呼吸结果 (HACOR) 评分是评估NIV患者稳定性的潜在工具.
研究的目的:
- 建立可靠的标准来识别急性呼吸衰竭的NIV患者,这些患者可以安全地转移到普通病房.
- 评估将稳定的NIV患者转移到较低急性设置的安全性和有效性.
主要方法:
- 一项追溯研究,从2021年7月到2022年12月,297名患者在急诊部高依赖病房 (ED-HDU) 接受急性呼吸衰竭的NIV治疗.
- 每天计算HACOR分数的时间.
- 合适的转移标准:HACOR评分≤2,不完全依赖于NIV (即能够与常规氧气或高流量鼻交替使用).
- 主要终点:所有原因的住院死亡率.
主要成果:
- 24小时后,38%的患者的HACOR得分≤2,与得分>2 (21%) 患者相比,死亡率 (11%) 显著降低.
- 在转移到普通病房的235名患者中,125人被认为是合适的,110人被认为是不合适的.
- 在不适当转移组 (21%) 与适当组 (7%) 的住院死亡率明显高.
- 即使排除了作为天花板疗法使用NIV治疗的患者,不适当的转移也显示死亡率增加 (14%与4%相比).
结论:
- 2或以下的HACOR得分,加上对NIV的低依赖,是安全将患者转移到普通病房的可靠指标.
- 实施这些标准可以优化患者管理,并可能降低NIV急性呼吸衰竭患者的住院死亡率.
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