在通风创伤性脑损伤患者中优化静脉血栓栓塞的预防时间:使用ACS-TQIP数据 (2017-2021) 进行回顾性队列研究 (2017-2021)
Heather X Rhodes-Lyons1, Adel Elkbuli2, Hazem Nasef3
1Center for Clinical Epidemiology and Population Health Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, WI, 54449, USA. rhodes.heather@marshfieldresearch.org.
概括
早期静脉血栓塞栓症预防 (VTEp) 在创伤性脑损伤 (TBI) 患者的机械呼吸机减少了低风险和中等风险组的呼吸机日. 接受非常早期VTEp的高风险TBI患者面临的死亡率增加.
科学领域:
- 神经科学是一个神经科学.
- 关键护理医学 关键护理医学
- 创伤外科 手术 创伤外科
背景情况:
- 接受机械呼吸的创伤性脑损伤 (TBI) 患者有高风险发生静脉血栓塞栓症 (VTE).
- 由于对内出血的担忧,在这些患者中进行VTE预防的最佳时间 (VTEp) 仍在争论中.
- 本研究研究了VTEp时间及其对TBI患者机械通风持续时间的影响.
研究的目的:
- 评估VTE预防时间和机械通风持续时间之间的关联,在孤立的TBI的成年患者.
- 评估风险分层对VTEp时间表结果的影响.
主要方法:
- 使用2017-2021年美国外科医生学院创伤质量计划参与者使用文件的回顾性队列研究.
- 包括成人患者 (≥15岁) 患有需要机械通风的孤立TBI.
- 通过修改的伯恩-诺伍德标准 (mBNC) 对出血风险和分类的VTEp时间 (≤24h,24-72h,≥72h) 进行分层的患者.
主要成果:
- 非常早期的VTEp (≤24小时) 与机械通风持续时间的显著减少有关,低风险的患者减少3.7天,中等风险的TBI患者减少2.8天.
- 接受非常早期VTEp的高风险TBI患者的死亡率增加 (21.3%).
结论:
- 非常早期的VTEp与低至中度风险TBI患者的呼吸器持续时间缩短有关,但在高风险患者中增加死亡率.
- 个性化,风险分层的VTEp策略对于通风TBI患者至关重要.
- 需要进行前性研究来验证这些发现,并指导临床实践的修改.
相关概念视频
01:29Venous Thrombosis III: Interprofessional Care
276
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
276
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
308
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
308
01:30Venous Thrombosis IV: Nursing Management
192
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
192
01:27Pulmonary Embolism III: Nursing Management
351
A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
351
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
284
The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
284
01:30Venous Thrombosis I: Introduction
351
Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
351