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输出预测得分 (ExPreS) 对重复输入ICU的预测得分的影响:一个随机对照试验
Julia Almeida Oliveira1, Fernanda Klein1, Natália Godoy Guzatti1
1Universidade do Oeste de Santa Catarina - UNOESC, Joaçaba, SC, Brazil.
输出预测得分 (ExPreS) 显示,在机械通风后,严重病情的成年人中,重新输入输出率下降的趋势. 虽然在初级分析中没有统计学意义,但ExPreS需要进一步调查以支持输出的决策.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统疗法 呼吸系统疗法
- 临床决策支持 临床决策支持
背景情况:
- 在自发呼吸试验 (SBT) 后,10-30%的重症患者中,输出输出失败使恢复复杂化.
- 输出预测得分 (ExPreS) 是为了识别患有输出失败高风险的患者而开发的.
- 没有随机对照试验评估ExPreS作为临床决策支持工具.
研究的目的:
- 为了确定使用ExPreS算法是否能在机械通风的成年人中减少48小时内再灌输率.
- 评估ExPreS作为指导输出管的决策和改善患者结果的工具.
- 评估ExPreS对二次结果的影响,如通风持续时间和ICU死亡率.
主要方法:
- 一个单中心,随机控制的优越性试验,涉及2个ICU的540名成年患者.
- 被通风24小时以上并通过SBT的患者被随机 (1:1) 分给标准护理或ExPreS引导的输出管.
- 主要结局是输出管失败,定义为在48小时内重新输入管.
主要成果:
- 对治疗意图的分析显示,ExPreS组 (8.0%) 与对照组 (13.0%),p=0.070.0%的输出失败率数值较低.
- 每项协议分析表明,ExPreS的输出失败率在统计学上显著降低 (7.3%对12.9%,p=0.042).
- 排气气流阻塞排除进一步降低了ExPreS组的故障率 (3.4%与9.1%,p=0.011);没有观察到通风持续时间或死亡率的差异.
结论:
- 输出预测得分 (ExPreS) 与标准护理相比,在48小时内重新输入的数量较低.
- 主要治疗意图分析没有达到统计学意义,但次要和探索性分析支持了有益的影响.
- 研究结果表明,ExPreS可能有助于输出的决定,但需要在更大,多中心的研究中得到确认.
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