Point of care testing: improving pediatric outcomes
Point of care testing: improving pediatric outcomes
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DOI：
10.1016/j.clinbiochem.2004.04.004
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发表时间：
2004-06-01
影响因子：
2.8
通讯作者：
Khan, D
中科院分区：
文献类型：
--
作者：
Rossi, AF;Khan, D
目的：目标导向治疗（GDT）已被证明可以降低危重疾病的发病率和死亡率。护理点测试（POCT）允许关键数据的快速周转时间（TAT），但表明改善结果的数据非常有限。这两种策略对改善先天性心脏手术后患者预后的影响从未被评估过。设计：从2001年7月开始，i-STAT手持式分析仪形式的POCT被纳入我们机构先天性心脏手术后患者的管理中。术后24小时连续测定血乳酸浓度。根据乳酸值，手术后药物治疗升级、减少或保持不变。前瞻性地收集结局数据以供以后回顾。将接受GDT方案的患者术后30天的死亡率与一组历史队列进行比较。使用RACHS-1评分系统确定所有手术的手术风险。环境：在一所拥有268张床位的独立儿科医院中，设有16张床位的心脏重症监护病房（CICU）。患者：将2001年7月至2003年7月（B组）手术的婴儿和新生儿的结果与我院1995年6月至2001年6月（A组）的历史对照进行比较。A组851例，B组378例，B组患者比A组更小、更年轻（中位体重3.8 vs 4.3 kg, P < 0.001；中位年龄42 vs 76天，P = 0.02）。测量和结果：B组的总死亡率低于A组（2.4%比6.2%,P < 0.007）。B组和A组新生儿死亡率显著降低（4.3% vs. 12%, P = 0.008），但婴儿死亡率无显著降低（0.9% vs. 2.6%, P = NS）。接受最高风险手术的患者（RACHS-1组5 + 6）与a组相比死亡率降低70% (9% vs 30%, P = 0.03)，但接受低风险手术的患者死亡率无统计学差异（RACHS-1组1和2，B组0.5% vs a组1.5%,P = NS）。结论：目标导向治疗与护理点检测相结合可显著降低先天性心脏手术患者的死亡率。这种改善在最年轻的患者和接受高风险手术的患者中最为明显。(C) 2004加拿大临床化学学会。版权所有。
Objective: Goal-directed therapy (GDT) has been proven to reduce morbidly and mortality in critical illness. Point of care testing (POCT) allows rapid turn around time (TAT) of critical data, yet data suggesting improved outcomes are very limited. The impact of these two strategies on improving outcomes for patients after congenital heart surgery has never been evaluated.Design: Beginning July 2001, POCT in the form of the i-STAT handheld analyzer was incorporated in the management of patients after congenital heart surgery at our institution. Blood lactate measurements were performed serially for 24 h after surgery. Based on a lactate value, medical therapy was escalated, diminished or left unchanged after surgery. Outcome data were collected prospectively for later review. Mortality at 30 days after surgery was compared for patients undergoing a GDT protocol to a group of historical cohorts. The operative risk for all operations was determined using the RACHS-1 scoring system.Setting: A 16-bed Cardiac Intensive Care Unit (CICU) in a 268-bed free-standing pediatric hospital.Patients: Outcomes of infants and neonates operated on from July 2001 through July 2003 (Group B) were compared to historical controls in our institution from June 1995 through June 2001 (Group A). There were 851 patients in Group A and 378 patients in Group B. Patients in Group B were smaller and younger than those in group A (median weight 3.8 vs. 4.3 kg, P < 0.001; median age 42 vs; 76 days, P = 0.02).Measurements and results: Overall mortality was lower for Group B as compared to Group A (2.4% vs. 6.2%, P < 0.007). Significant reduction in mortality between Group B and Group A was noted in neonates (4.3% vs. 12%, P = 0.008) but did not reach significance in infants (0.9% vs. 2.6%, P = NS). Patients undergoing the highest-risk operations (RACHS-1 groups 5 + 6) had a 70% reduction in mortality when comparing Group B to Group A, (9% vs. 30%, P = 0.03), but no statistical difference in mortality was noted in those patients undergoing lower-risk operations (RACHS-1 groups 1 and 2, Group B 0.5% vs. Group A 1.5%, P = NS).Conclusions: The combination of goal-directed therapy and point of care testing significantly reduced mortality in patients undergoing congenital heart surgery. This improvement is greatest in the youngest patients and those undergoing higher-risk surgeries. (C) 2004 The Canadian Society of Clinical Chemists. All rights reserved.