Factors influencing pediatric transfusion: A complex decision impacting quality of care.
Factors influencing pediatric transfusion: A complex decision impacting quality of care.
复制标题
影响儿科输血的因素：影响护理质量的复杂决策。
DOI：
10.1111/trf.17364
复制
发表时间：
2023
期刊：
影响因子：
2.9
通讯作者：
Doctor,Allan
中科院分区：
文献类型：
--
作者：
Steffen,KatherineM;Spinella,PhilipC;Holdsworth,LauraM;Ford,Mackenzie;Lee,GraceM;Asch,StevenM;Proctor,EnolaK;Doctor,Allan
红细胞输注的风险可能超过儿科重症监护病房（PICU）中许多患者的益处，但输血和贫血实验倡议（TAXI）的指南尚未得到一致采用。我们试图找出影响PICU输血决策的因素，以探索潜在的障碍和促进因素，以实施guidelines.Study Design and MethodsA共有50名ICU提供者在8个不同类型的美国ICU（非心脏PICU，心血管ICU，合并单位）和可变大小（11-32张病床）完成半结构化访谈。提供者包括ICU主治医师和实习生、执业护士、护士和专科医生。访谈研究了影响输血决策，输血实践和供应商的信念的因素。定性分析采用框架方法。提供者的角色和单位之间的总结数据进行了比较，考虑到识别模式和独特的信息statements.ResultsProviders引用的临床，生理，解剖和后勤因素，他们认为在作出输血的决定。改善携氧能力、血流动力学和灌注、呼吸功能、容量不足和校正实验室值是输血的原因。其他受欢迎的好处包括缓解贫血症状，提高ICU吞吐量和减少血液浪费。不同角色的提供者处理输血决策的方式不同，与其他ICU提供者相比，护士和专科医生之间的差异最大。虽然ICU主治医生最常做出输血的决定，但所有提供者都影响了决策制定。讨论输血指南的实施需要多专业的方法，强调输血的已知风险，其有限的益处，并强调限制性方法的安全性和益处的证据。
BackgroundThe risks of red blood cell transfusion may outweigh the benefits for many patients in pediatric intensive care units (PICUs), but guidelines from the Transfusion and Anemia eXpertise Initiative (TAXI) have not been consistently adopted. We sought to identify factors that influenced transfusion decision‐making in PICUs to explore potential barriers and facilitators to implementing the guidelines.Study Design and MethodsA total of 50 ICU providers working in eight US ICUs of different types (non‐cardiac PICUs, cardiovascular ICUs, combined units) and variable sizes (11–32 beds) completed semi‐structured interviews. Providers included ICU attendings and trainees, nurse practitioners, nurses, and subspecialty physicians. Interviews examined factors that influenced transfusion decisions, transfusion practices, and provider beliefs. Qualitative analysis utilized a Framework Approach. Summarized data was compared between provider roles and units with consideration to identify patterns and unique informative statements.ResultsProviders cited clinical, physiologic, anatomic, and logistic factors they considered in making transfusion decisions. Improving oxygen carrying capacity, hemodynamics and perfusion, respiratory function, volume deficits, and correcting laboratory values were among the reasons given for transfusion. Other sought‐after benefits included alleviating symptoms of anemia, improving ICU throughput, and decreasing blood waste. Providers in different roles approached transfusion decisions differently, with the largest differences noted between nurses and subspecialists as compared with other ICU providers. While ICU attendings most often made the decision to transfuse, all providers influenced the decision‐making.DiscussionImplementation of transfusion guidelines requires multi‐professional approaches that emphasize the known risks of transfusion, its limited benefits, and highlight evidence around the safety and benefit of restrictive approaches.