在输管治疗的ICU患者中,遵守镇静方案建议
Taylor M Smith1,2, Caroline Pane1, Soseh Hovasapian1
1Department of Cardiology, Boston Children's Hospital, Boston, MA.
儿科重症监护室 (PICU) 的镇静实践往往偏离了既定的协议,经常错过了药物定位的机会. 改善对镇静方案的遵守对于最大限度地降低危急儿童长期镇静相关的风险至关重要.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 药理学 药理学是指药理学的学科.
- 提高质量 提高科学 提高质量
背景情况:
- 危急病患儿童的镇静提供了挑战,低和过度镇静都有负面后果.
- 标准化镇静方案旨在减少变异性,最大限度地减少药物暴露,并改善患者的治疗结果.
- 在儿科重症监护室 (PICU) 遵守协议还不清楚.
研究的目的:
- 量化在重症儿童中遵守镇静方案的数量.
- 在一个大型单中心队列中,评估镇静方案与实际输液定位实践之间的一致性.
主要方法:
- 在三级护理儿童医院的三个PICU中进行的回顾性队列研究.
- 包括接受机械通风超过24小时,并在2011年至2023年期间至少接受一次镇静剂输液的患者.
- 计算了对镇静方案定位的五个关键指标的遵守.
主要成果:
- 对8108名患者和9670次接触的分析显示,所有PICU的协议遵守率始终很低.
- 输液在指示时很少增加 (92.5%错过) 并且在建议时经常没有减少 (95.5%错过).
- 在54.7%的机会中出现过早的剂量增加,只有16.2%的短期输液按建议中止.
结论:
- 在PICU中,镇静剂定位经常偏离协议建议,导致错过了积极管理的机会.
- 改善对镇静方案的遵守是质量改善的关键目标,以减轻长期镇静的风险.
- 未来的研究应该确定遵守的障碍,并开发干预措施,如临床决策支持工具,以加强遵守.
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