Cardiorespiratory instability before and after implementing an integrated monitoring system
Cardiorespiratory instability before and after implementing an integrated monitoring system
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DOI：
10.1097/ccm.0b013e3181fb7b1c
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发表时间：
2011-01-01
影响因子：
8.8
通讯作者：
Pinsky, Michael R.
中科院分区：
文献类型：
--
作者：
Hravnak, Marilyn;DeVita, Michael A.;Pinsky, Michael R.
目的：在监测的降压病房患者中，可能无法检测到呼吸不稳定。我们探讨了是否使用一个集成的监测系统，不断融合单一的非侵入性监测参数，（心率、呼吸频率、血压和外周血氧饱和度）转换为AN不稳定指数值（INDEX）与我们的单参数心肺不稳定关注标准相关，以及护士对INDEX警报的反应是否与不稳定减少相关。设计：连续8周、16周和8周阶段的前瞻性纵向评价（分别为I期、II期和III期）。设置：一个城市三级护理中心的24床创伤降压单位。患者：所有监测患者。干预：I期：患者接受连续单通道监测（心率、呼吸频率、血压和外周血氧饱和度）和标准护理;记录但不显示指数背景。第二阶段：对索引进行背景记录;对工作人员进行使用教育。第三阶段：测量和主要结果：任何监测的参数，即使是短暂地超出局部心肺不稳定的关注触发（心率140次/分，呼吸频率36次/分，收缩压200 mm Hg，舒张压>110 mm Hg，外周血氧饱和度100 mm Hg，心率140次/分，呼吸频率36次/分，收缩压> 100 mm Hg，外周血氧饱和度> 100 mm Hg）。
Objectives: Cardiorespiratory instability may be undetected in monitored step-down unit patients. We explored whether using an integrated monitoring system that continuously amalgamates single noninvasive monitoring parameters (heart rate, respiratory rate, blood pressure, and peripheral oxygen saturation) into AN instability index value (INDEX) correlated with our single-parameter cardiorespiratory instability concern criteria, and whether nurse response to INDEX alert for patient attention was associated with instability reduction.Design: Prospective, longitudinal evaluation in sequential 8-, 16-, and 8-wk phases (phase I, phase II, and phase III, respectively).Setting: A 24-bed trauma step-down unit in single urban tertiary care center.Patients: All monitored patients.Interventions: Phase I: Patients received continuous single-channel monitoring (heart rate, respiratory rate, blood pressure, and peripheral oxygen saturation) and standard care; INDEX background was recorded but not displayed. Phase II: INDEX was background-recorded; staff was educated on use. Phase III: Staff used a clinical response algorithm for INDEX alerts.Measurement and Main Results: Any monitored parameters even transiently beyond local cardiorespiratory instability concern triggers (heart rate of 140 beats/min, respiratory rate of 36 breaths/min, systolic blood pressure of 200 mm Hg, diastolic blood pressure of >110 mm Hg, and peripheral oxygen saturation of