Improving Prone Positioning for Severe Acute Respiratory Distress Syndrome during the COVID-19 Pandemic. An Implementation-Mapping Approach.
Improving Prone Positioning for Severe Acute Respiratory Distress Syndrome during the COVID-19 Pandemic. An Implementation-Mapping Approach.
复制标题
COVID-19大流行期间改善严重急性呼吸窘迫综合征的俯卧位实现映射方法。
DOI：
10.1513/annalsats.202005-571oc
复制
发表时间：
2021-03
影响因子：
8.3
通讯作者：
Kerlin MP
中科院分区：
文献类型：
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作者：
Klaiman T;Silvestri JA;Srinivasan T;Szymanski S;Tran T;Oredeko F;Sjoding MW;Fuchs BD;Maillie S;Jablonski J;Lane-Fall MB;Kerlin MP
基本原理：俯卧姿势可降低严重急性呼吸窘迫综合征（ARDS）患者的死亡率，这是2019年严重冠状病毒病（COVID-19）的一个特征。尽管如此，大多数患有ARDS的患者并没有接受这种挽救生命的治疗。目的：确定使用俯卧位的决定因素，制定具体的实施策略，并将策略纳入对COVID-19危机的总体应对。方法：我们使用了一种由实施科学框架指导的实施映射方法。我们对30名重症监护室（ICU）临床医生进行了半结构化访谈，他们在宾夕法尼亚医学卫生系统和密歇根大学医学中心的12个ICU中工作。我们使用实施研究综合框架进行了专题分析。然后，我们与一个由伊斯兰法院联盟领导人组成的工作队进行了三个焦点小组，利用实施变革框架的专家建议制定了一个实施菜单。该等实施策略已作为Penn Medicine COVID-19疫情应对措施的一部分进行调整。结果如下：我们确定了五个广泛的主题，包括知识，资源，替代疗法，团队文化和患者因素，共同跨越所有五个实施研究领域的综合框架的决定因素。该工作组制定了五项具体的实施战略，包括教育推广、学习协作、临床协议、俯卧位团队和自动警报，其中的要素在宾夕法尼亚大学医学院迅速实施。结论：我们确定了五个广泛的主题的决定因素，以证据为基础的使用俯卧位的严重ARDS和几个具体的策略，以解决这些问题。这些策略对于快速实施可能是可行的，以增加COVID-19严重ARDS的俯卧位使用。
Rationale: Prone positioning reduces mortality in patients with severe acute respiratory distress syndrome (ARDS), a feature of severe coronavirus disease 2019 (COVID-19). Despite this, most patients with ARDS do not receive this lifesaving therapy. Objectives: To identify determinants of prone-positioning use, to develop specific implementation strategies, and to incorporate strategies into an overarching response to the COVID-19 crisis. Methods: We used an implementation-mapping approach guided by implementation-science frameworks. We conducted semistructured interviews with 30 intensive care unit (ICU) clinicians who staffed 12 ICUs within the Penn Medicine Health System and the University of Michigan Medical Center. We performed thematic analysis using the Consolidated Framework for Implementation Research. We then conducted three focus groups with a task force of ICU leaders to develop an implementation menu, using the Expert Recommendations for Implementing Change framework. The implementation strategies were adapted as part of the Penn Medicine COVID-19 pandemic response. Results: We identified five broad themes of determinants of prone positioning, including knowledge, resources, alternative therapies, team culture, and patient factors, which collectively spanned all five Consolidated Framework for Implementation Research domains. The task force developed five specific implementation strategies, including educational outreach, learning collaborative, clinical protocol, prone-positioning team, and automated alerting, elements of which were rapidly implemented at Penn Medicine. Conclusions: We identified five broad themes of determinants of evidence-based use of prone positioning for severe ARDS and several specific strategies to address these themes. These strategies may be feasible for rapid implementation to increase use of prone positioning for severe ARDS with COVID-19.