使用全国性ICU数据库开发和验证用于预测败血症患者气管切除术的STeP得分:一项回顾性观察性研究
Kazuya Kikutani1, Mitsuaki Nishikimi2, Michihito Kyo2,3
1Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. kikutani@hiroshima-u.ac.jp.
Journal of intensive care
|November 14, 2025
概括
我们开发了一种败血症轨道切除术早期预测 (STeP) 评分,以识别高风险的轨道切除术感染败血症的ICU患者. 这种工具有助于早期规划机械通风和气管切除决定.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 医疗信息学 医疗信息学
背景情况:
- 机械通风在ICU中的败血症患者中很常见.
- 这些患者的一小部分需要气管切除术.
- 早期识别气管切除术风险对于决策至关重要.
研究的目的:
- 在败血症患者中开发和验证早期气管切除术的预测模型.
- 创建一个简化的临床使用风险评分.
- 改善临床沟通和关于气管切除术的决策.
主要方法:
- 使用日本重症监护患者数据库 (JIPAD) 进行全国性的回顾性研究.
- 包括成人败血症患者 (SOFA评分≥2,不包括病毒性肺炎) 需要机械通风 (2018-2022).
- 开发了使用LASSO回归的败血症轨道切除术早期预测 (STeP) 模型,并从ICU入院24小时内可用的8个预测因素中得出简化的STeP得分.
主要成果:
- 在7357名符合条件的患者中,13.8%的患者在14天内接受了气管切除术.
- STeP模型显示出良好的歧视 (验证时AUC为0.74).
- 根据STeP得分,患者被分为低风险 (4.0%),中度风险 (13.6%) 和高风险 (27.1%) 的风险组.
结论:
- 开发并验证了一种强大的预测模型和简化的STeP评分,用于ICU败血症患者的早期气管切除术.
- 使用STeP得分的早期风险分层可以支持及时的气管切除术规划.
- 一个公开的网络计算器可以方便床边实施.
相关概念视频
Tracheostomy Suctioning I: Pre-Procedural Steps
2.0K
Tracheostomy suctioning is a critical procedure healthcare professionals perform to maintain a patent airway in patients with a tracheostomy tube. This procedure is necessary when secretions accumulate in the airway, causing respiratory distress. Here is a step-wise procedural guide for performing tracheostomy suctioning using an open system.
Equipment Required
First, gather all necessary equipment: a sterile suction catheter, a sterile disposable container, sterile gloves, a towel or...
Equipment Required
First, gather all necessary equipment: a sterile suction catheter, a sterile disposable container, sterile gloves, a towel or...
2.0K
Tracheostomy Care I: Pre-procedural Steps
951
A tracheostomy is a surgical technique that involves making an incision in the neck to provide access to the trachea. It is frequently used in medical conditions such as airway obstruction and prolonged mechanical ventilation. Effective nursing management is crucial for the long-term success of a tracheostomy.
Required Equipment
The equipment necessary for tracheostomy care includes:
Required Equipment
The equipment necessary for tracheostomy care includes:
951
Tracheostomy Care II: Procedure
1.3K
Tracheostomy care is an essential nursing skill that involves cleaning and maintaining a tracheostomy tube to prevent infection and other complications. Here's a step-by-step guide explaining each procedure with its rationale. Note that disposable gloves are to be worn at all times and changed as often as needed to maintain a sterile work environment, and to protect both patient and healthcare worker.
Step 1: Perform hand hygiene, and put on personal protective equipment: gown, gloves, mask...
Step 1: Perform hand hygiene, and put on personal protective equipment: gown, gloves, mask...
1.3K
Tracheostomy Suctioning II: Procedure
1.4K
Tracheostomy suctioning is a vital nursing procedure that involves removing secretions from the tracheostomy tube to maintain airway patency and prevent respiratory complications. Nurses need to understand the proper technique for tracheostomy suctioning to ensure patient safety and comfort. In this guide, we will outline the step-by-step process for performing tracheostomy suctioning, including preparing the sterile field, donning personal protective equipment (PPE), lubricating and connecting...
1.4K
Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
1.8K
Oxygen therapy is a pivotal aspect of medical care, particularly for patients with respiratory ailments. Two prominent oxygen-delivering systems include the Venturi mask and the transtracheal oxygen catheter.
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
1.8K
Tracheostomy Decannulation
1.1K
Tracheostomy decannulation is a significant milestone in the liberation of mechanically ventilated patients. Despite its importance, there is no universally accepted protocol for this procedure. This demands an evidence-based, individualized approach.
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
1.1K

