{"title":"心跳骤停后的捆绑护理提高了常温下的护理质量和临床效果。","authors":"Andrew J Caddell, Dave Nagpal, Ahmed F Hegazy","doi":"10.1177/08850666231223482","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Temperature targets in patients with cardiac arrest and return of spontaneous circulation (ROSC) have changed. Changes to higher temperature targets have been associated with higher breakthrough fevers and mortality. A post-ROSC normothermia bundle was developed to improve compliance with temperature targets.</p><p><strong>Methods: </strong>In August 2021, \"ad hoc\" normothermia at the discretion of the attending intensivist was initiated. In December 2021, a post-ROSC normothermia protocol was implemented, incorporating a rigorous, stepwise approach to fever prevention (temperature ≥ 37.8). We conducted a before-after cohort study of all adult patients post-ROSC who survived to intensive care unit admission between August 1, 2021, and April 1, 2022. They were divided into \"ad hoc\" and \"protocol\" groups. Clinical outcomes compared included fevers, active cooling, and paralytic use.</p><p><strong>Results: </strong>Fifty-eight post-ROSC patients were admitted; 24 in the \"ad hoc\" and 34 in the \"protocol\" groups. Patient demographics were similar between groups. The \"ad hoc\" group had more shockable rhythms (67% vs 24%, <i>P</i> = .001) and cardiac catheterizations (42% vs 15%, <i>P</i> = .03). The \"protocol\" group were significantly less likely to have a fever at 40 h (6% vs 40%, <i>P</i> < .001) and 72 h (14% vs 65%, <i>P</i> ≤ .001). Patients in the normothermia \"protocol\" used significantly less neuromuscular blocking agents (24% vs 50%, <i>P</i> = .05). The normothermia \"protocol\" resulted in similar mortality (56% vs 58%, <i>P</i> = 1.0).</p><p><strong>Conclusion: </strong>Use of a normothermia \"protocol\" resulted in fewer fevers and less neuromuscular blocker administration compared to \"ad hoc\" management. A protocolized approach for improved quality of care should be considered in institutions adopting normothermia.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149385/pdf/","citationCount":"0","resultStr":"{\"title\":\"Postarrest Care Bundle Improves Quality of Care and Clinical Outcomes in the Normothermia Era.\",\"authors\":\"Andrew J Caddell, Dave Nagpal, Ahmed F Hegazy\",\"doi\":\"10.1177/08850666231223482\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Temperature targets in patients with cardiac arrest and return of spontaneous circulation (ROSC) have changed. Changes to higher temperature targets have been associated with higher breakthrough fevers and mortality. A post-ROSC normothermia bundle was developed to improve compliance with temperature targets.</p><p><strong>Methods: </strong>In August 2021, \\\"ad hoc\\\" normothermia at the discretion of the attending intensivist was initiated. In December 2021, a post-ROSC normothermia protocol was implemented, incorporating a rigorous, stepwise approach to fever prevention (temperature ≥ 37.8). We conducted a before-after cohort study of all adult patients post-ROSC who survived to intensive care unit admission between August 1, 2021, and April 1, 2022. They were divided into \\\"ad hoc\\\" and \\\"protocol\\\" groups. Clinical outcomes compared included fevers, active cooling, and paralytic use.</p><p><strong>Results: </strong>Fifty-eight post-ROSC patients were admitted; 24 in the \\\"ad hoc\\\" and 34 in the \\\"protocol\\\" groups. Patient demographics were similar between groups. The \\\"ad hoc\\\" group had more shockable rhythms (67% vs 24%, <i>P</i> = .001) and cardiac catheterizations (42% vs 15%, <i>P</i> = .03). The \\\"protocol\\\" group were significantly less likely to have a fever at 40 h (6% vs 40%, <i>P</i> < .001) and 72 h (14% vs 65%, <i>P</i> ≤ .001). Patients in the normothermia \\\"protocol\\\" used significantly less neuromuscular blocking agents (24% vs 50%, <i>P</i> = .05). The normothermia \\\"protocol\\\" resulted in similar mortality (56% vs 58%, <i>P</i> = 1.0).</p><p><strong>Conclusion: </strong>Use of a normothermia \\\"protocol\\\" resulted in fewer fevers and less neuromuscular blocker administration compared to \\\"ad hoc\\\" management. A protocolized approach for improved quality of care should be considered in institutions adopting normothermia.</p>\",\"PeriodicalId\":16307,\"journal\":{\"name\":\"Journal of Intensive Care Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149385/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Intensive Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/08850666231223482\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/4 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Intensive Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/08850666231223482","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/4 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Postarrest Care Bundle Improves Quality of Care and Clinical Outcomes in the Normothermia Era.
Purpose: Temperature targets in patients with cardiac arrest and return of spontaneous circulation (ROSC) have changed. Changes to higher temperature targets have been associated with higher breakthrough fevers and mortality. A post-ROSC normothermia bundle was developed to improve compliance with temperature targets.
Methods: In August 2021, "ad hoc" normothermia at the discretion of the attending intensivist was initiated. In December 2021, a post-ROSC normothermia protocol was implemented, incorporating a rigorous, stepwise approach to fever prevention (temperature ≥ 37.8). We conducted a before-after cohort study of all adult patients post-ROSC who survived to intensive care unit admission between August 1, 2021, and April 1, 2022. They were divided into "ad hoc" and "protocol" groups. Clinical outcomes compared included fevers, active cooling, and paralytic use.
Results: Fifty-eight post-ROSC patients were admitted; 24 in the "ad hoc" and 34 in the "protocol" groups. Patient demographics were similar between groups. The "ad hoc" group had more shockable rhythms (67% vs 24%, P = .001) and cardiac catheterizations (42% vs 15%, P = .03). The "protocol" group were significantly less likely to have a fever at 40 h (6% vs 40%, P < .001) and 72 h (14% vs 65%, P ≤ .001). Patients in the normothermia "protocol" used significantly less neuromuscular blocking agents (24% vs 50%, P = .05). The normothermia "protocol" resulted in similar mortality (56% vs 58%, P = 1.0).
Conclusion: Use of a normothermia "protocol" resulted in fewer fevers and less neuromuscular blocker administration compared to "ad hoc" management. A protocolized approach for improved quality of care should be considered in institutions adopting normothermia.
期刊介绍:
Journal of Intensive Care Medicine (JIC) is a peer-reviewed bi-monthly journal offering medical and surgical clinicians in adult and pediatric intensive care state-of-the-art, broad-based analytic reviews and updates, original articles, reports of large clinical series, techniques and procedures, topic-specific electronic resources, book reviews, and editorials on all aspects of intensive/critical/coronary care.