[大学急诊科非创伤性危重症儿童复苏室管理的回顾性分析(OBSERvE-DUS-PED 研究)]。

Die Anaesthesiologie Pub Date : 2024-10-01 Epub Date: 2024-09-02 DOI:10.1007/s00101-024-01457-7
Claudia Priebe, Hans Martin Bosse, Mark Michael, Olaf Picker, Michael Bernhard, Juliane Tautz
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摘要

背景:为非创伤性危重症儿童建立复苏室管理似乎很有意义。本研究收集了在复苏室接受治疗的非创伤性危重症儿童患者的数据:回顾性OBSERvE-DUS-PED研究(2019年11月-2022年10月)记录了儿科患者(年龄结果:研究包括52名儿科复苏室患者。14-17岁的青少年最多,占总数的37%,新生儿/婴儿(0-1岁)最少,占8%。根据 ABCDE 问题分类,最常见的症状是意识障碍(D),占 61%;心血管衰竭(C),占 25%;呼吸功能不全(B),占 6%;气道阻塞(A)和暴露/环境(E)问题各占 4%。院外和院内急救程序的执行频率如下:静脉(58% 对 65%)、骨内(14% 对 2%)和中心静脉通路(0% 对 12%)、有创气道管理(35% 对 8%)、心肺复苏(21% 对 10%)、血管加压(15% 对 17%)和动脉内压力测量(0% 对 17%)。复苏室管理的平均持续时间为 70 ± 43 分钟。30天死亡率为17%:OBSERvE-DUS-PED研究表明,非创伤性儿科重症患者在院外和院内管理方面都面临着重大挑战。由于转诊诊断的多样性和复杂性以及患者面临的直接生命威胁,在现有的物质、基础设施和人力资源条件下,主要在急诊室的复苏室治疗这类患者似乎是明智之举。
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[Retrospective analysis of the resuscitation room management of nontraumatic critically ill children in a university emergency department (OBSERvE-DUS-PED study)].

Background: The establishment of a resuscitation room management for nontraumatic critically ill children appears to make sense. This study collected data of pediatric patients suffering from nontraumatic critically ill conditions treated in a resuscitation room.

Methods: The retrospective OBSERvE-DUS-PED study (November 2019-October 2022) recorded pediatric patients (age < 18 years) who were admitted to the emergency department (ED) for resuscitation room care. The routinely documented data on treatment were taken from the hospital information system MEDICO® and the patient data management system COPRA® in accordance with the OBSERvE dataset. The study was approved by the Ethics Committee of the Medical Faculty of the Heinrich Heine University (2023-2377).

Results: The study included 52 pediatric resuscitation room patients. Adolescents aged 14-17 years were the most frequent in the cohort representing 37% of the total and neonates/infants (0-1 year) were lowest at 8%. The most common symptoms categorized according to ABCDE problems were disturbance of consciousness (D) at 61%, cardiovascular failure (C) at 25%, respiratory insufficiency (B) at 6%, airway obstruction (A) and exposure/environment (E) problems each at 4%. The out-of-hospital and in-hospital emergency procedures were performed with the following frequencies: venous (58% vs. 65%), intraosseous (14% vs. 2%) and central venous access (0% vs. 12%), invasive airway management (35% vs. 8%), cardiopulmonary resuscitation (21% vs. 10%), vasopressors (15% vs. 17%), and intra-arterial pressure measurement (0% vs. 17%). The mean duration of resuscitation room management was 70 ± 43 min. The 30-day mortality was 17%.

Conclusion: The OBSERvE-DUS-PED study demonstrates the major challenges in the care of critically ill nontraumatic pediatric patients, both in out-of-hospital and in-hospital management. The variety and complexity of the referral diagnoses as well as the immediate vital threat to the patients make it appear sensible to treat such patients primarily in a resuscitation room of the ED due to the available material, infrastructural and personnel resources.

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