Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Quality Metrics in Patients Undergoing Decompressive Craniectomy and Endoscopic Clot Evacuation after Spontaneous Supratentorial Intracerebral Hemorrhage: A Retrospective Observational
Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Quality Metrics in Patients Undergoing Decompressive Craniectomy and Endoscopic Clot Evacuation after Spontaneous Supratentorial Intracerebral Hemorrhage: A Retrospective Observational
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自发性幕上脑出血后接受去骨瓣减压术和内镜下血块清除术的患者的麻醉学表现改进和报告交换 (ASPIRE) 质量指标：回顾性观察
DOI：
10.1097/ana.0000000000000912
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发表时间：
2023
影响因子：
3.7
通讯作者：
Vavilala,MonicaS
中科院分区：
文献类型：
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作者：
Lele,AbhijitV;Fong,ChristineT;Newman,Shu-Fang;O'Reilly-Shah,Vikas;Walters,AndrewM;Athiraman,Umeshkumar;Souter,MichaelJ;Levitt,MichaelR;Vavilala,MonicaS
背景：我们报告了6个与自发性幕上脑出血（sICH.Methods）后接受去骨瓣减压术或内镜下血凝块清除术的患者相关的麻醉学性能改进和报告交换（ASPIRE）质量指标（QM）的依从性：急性肾损伤（阿基-01）;平均动脉压< 65 mm Hg持续时间少于15分钟（BP-03）;心肌损伤（CARD-02）;结果：该研究包括95名患者（70%男性），中位（四分位数范围）年龄为55（47至66）岁，ICH评分为2（1至3），在sICH后接受颅骨切除术（n= 55）或内窥镜凝块清除术（n= 40）。归因于sICH的院内死亡率为23%（n= 22）。美国麻醉医师协会身体状态5级（n= 16）、术前肾小球滤过率降低（n= 5）、心肌肌钙蛋白升高（n= 21）和术中实验室检查无高血糖（n= 71）的患者，病例结束时未拔管（n= 62）或未接受神经肌肉阻滞剂（n= 3）的患者，根据预先确定的ASPIRE排除标准，将急诊手术患者（n= 64）从各自的ASPIRE QM分析中排除。对于其余患者，ASPIRE QM的依从性为：阿基-01，颅骨切除术34%，内镜下血凝块清除1%; BP-03，颅骨切除术72%，血凝块清除73%; CARD-02，两组均为100%; GLU-03，颅骨切除术67%，血凝块清除100%; NMB-02，血凝块清除79%，以及;结论：本研究发现，接受去骨瓣减压术或内镜下凝块清除术的sICH患者对ASPIRE QM的依从性存在差异。从个体ASPIRE指标中排除的患者数量相对较多是一个主要限制。
Background:We report adherence to 6 Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) quality metrics (QMs) relevant to patients undergoing decompressive craniectomy or endoscopic clot evacuation after spontaneous supratentorial intracerebral hemorrhage (sICH).Methods:In this retrospective observational study, we describe adherence to the following ASPIRE QMs: acute kidney injury (AKI-01); mean arterial pressure< 65 mm Hg for less than 15 minutes (BP-03); myocardial injury (CARD-02); treatment of high glucose (> 200 mg/dL, GLU-03); reversal of neuromuscular blockade (NMB-02); and perioperative hypothermia (TEMP-03).Result:The study included 95 patients (70% male) with median (interquartile range) age 55 (47 to 66) years and ICH score 2 (1 to 3) undergoing craniectomy (n= 55) or endoscopic clot evacuation (n= 40) after sICH. In-hospital mortality attributable to sICH was 23%(n= 22). Patients with American Society of Anesthesiologists physical status class 5 (n= 16), preoperative reduced glomerular filtration rate (n= 5), elevated cardiac troponin (n= 21) and no intraoperative labs with high glucose (n= 71), those who were not extubated at the end of the case (n= 62) or did not receive a neuromuscular blocker given (n= 3), and patients having emergent surgery (n= 64) were excluded from the analysis for their respective ASPIRE QM based on predetermined ASPIRE exclusion criteria. For the remaining patients, the adherence to ASPIRE QMs were: AKI-01, craniectomy 34%, endoscopic clot evacuation 1%; BP-03, craniectomy 72%, clot evacuation 73%; CARD-02, 100% for both groups; GLU-03, craniectomy 67%, clot evacuation 100%; NMB-02, clot evacuation 79%, and; TEMP-03, clot evacuation 0% with hypothermia.Conclusion:This study found variable adherence to ASPIRE QMs in sICH patients undergoing decompressive craniectomy or endoscopic clot evacuation. The relatively high number of patients excluded from individual ASPIRE metrics is a major limitation.