Utilizing a Collaborative Learning Model to Promote Early Extubation Following Infant Heart Surgery.
Utilizing a Collaborative Learning Model to Promote Early Extubation Following Infant Heart Surgery.
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DOI：
10.1097/pcc.0000000000000918
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发表时间：
2016-10
期刊：
影响因子：
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通讯作者：
Pediatric Heart Network Investigators
中科院分区：
文献类型：
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作者：
Mahle WT;Nicolson SC;Hollenbeck-Pringle D;Gaies MG;Witte MK;Lee EK;Goldsworthy M;Stark PC;Burns KM;Scheurer MA;Cooper DS;Thiagarajan R;Sivarajan VB;Colan SD;Schamberger MS;Shekerdemian LS;Pediatric Heart Network Investigators
确定协作学习策略衍生的临床实践指南（CPG）是否可以缩短婴儿心脏手术后气管插管的时间。在CPG实施前和实施后的12个月内，在参与协作的四个中心（活动中心）从儿科心脏网络收集的前瞻性和回顾性数据与来自未参与协作学习的五个PHN中心（对照中心）的数据进行了比较。收集了2次索引手术后婴儿的数据：1）主动脉孤立性缩窄修复术（出生-365天）和2）法洛四联症修复术（29-365天）。活性研究中心有240例受试者符合CPG的条件，对照研究中心有259例受试者符合CPG的条件。实施CPG后，活动部位的早期拔管率从11.7%显著增加到66.9%（P<0.001），而重新插管率没有增加。活动部位术后插管的中位持续时间从21.2小时降至4.5小时（p<0.001）。对照部位的早期拔管率无统计学显著变化（11.7%-13.7%）（p=0.63）。在活动中心，CPG实施对整个队列的重症监护室（ICU）中位住院时间（LOS）无统计学显著影响（实施前71.9小时vs实施后69.2小时，p=0.29）。法洛四联症亚组的ICU LOS有缩短的趋势（实施前为71.6小时，实施后为54.2小时，p=0.068）。合作学习策略设计的CPG显着增加了早期拔管率，而没有改变的再插管率。早期拔管CPG对术后ICU LOS无明显影响。
To determine whether a collaborative learning strategy derived clinical practice guideline (CPG) can reduce the duration of endotracheal intubation following infant heart surgery. Prospective and retrospective data collected from the Pediatric Heart Network in the 12 months pre- and post-CPG implementation at the four sites participating in the collaborative (active sites) compared to data from five PHN centers not participating in collaborative learning (control sites). Data were collected for infants following 2 index operations: 1) repair of isolated coarctation of the aorta (birth-365 days) and 2) repair of tetralogy of Fallot (29–365 days). There were 240 subjects eligible for the CPG at active sites and 259 subjects at control sites. After CPG implementation, the rate of early extubation at active sites increased significantly from 11.7% to 66.9% (p<0.001) with no increase in reintubation rate. The median duration of post-operative intubation among active sites decreased from 21.2 hours to 4.5 hours (p<.001). No statistically significant change in early extubation rates was found in the control sites 11.7% to 13.7% (p=0.63). At active sites CPG implementation had no statistically significant impact on median intensive care unit (ICU) length of stay (LOS) (71.9 hours pre- vs. 69.2 post-implementation, p=0.29) for the entire cohort. There was a trend toward shorter ICU LOS in the tetralogy of Fallot subgroup (71.6 hours pre- vs. 54.2 post-implementation, p=0.068). A collaborative learning strategy designed CPG significantly increased the rate of early extubation with no change in the rate of reintubation. The early extubation CPG did not significantly change post-operative ICU LOS.