Vital Signs Directed Therapy: Improving Care in an Intensive Care Unit in a Low-Income Country
Vital Signs Directed Therapy: Improving Care in an Intensive Care Unit in a Low-Income Country
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DOI：
10.1371/journal.pone.0144801
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发表时间：
2015-12-22
期刊：
影响因子：
3.7
通讯作者：
Konrad, David
中科院分区：
文献类型：
--
作者：
Baker, Tim;Schell, Carl Otto;Konrad, David
背景全球危重病护理越来越受到人们的关注。每年有数百万人死亡，全世界的危重病负担比一般估计的要大。低收入国家（LIC）的危重病比例更高，但在这种情况下，危重病护理设施稀缺。在高收入国家，利用异常生命体征来识别危重疾病并触发医疗干预的做法已很常见，但在低收入国家尚未进行调查。本研究的目的是评估是否引入了生命体征导向治疗方案，改善急性护理和降低死亡率在重症监护病房（ICU）在Tanzana.Methods和FindingsProspective，前后干预研究在ICU的一所大学医院在坦桑尼亚。一个上下文适当的协议，定义严重异常的生命体征的危险水平，并规定了急性治疗反应，在四周内使用敏化，培训，工作援助，监督和反馈。采用回归模型对入院时和ICU护理期间的危险体征的急性治疗和院内死亡率进行了实施前后的比较。包括447名患者的危险迹象：269名实施前和178名实施后。实施后，对危险体征的急性治疗率较高（入院时：72.9% vs 23.1%，p
BackgroundGlobal Critical Care is attracting increasing attention. At several million deaths per year, the worldwide burden of critical illness is greater than generally appreciated. Low income countries (LICs) have a disproportionally greater share of critical illness, and yet critical care facilities are scarce in such settings. Routines utilizing abnormal vital signs to identify critical illness and trigger medical interventions have become common in high-income countries but have not been investigated in LICs. The aim of the study was to assess whether the introduction of a vital signs directed therapy protocol improved acute care and reduced mortality in an Intensive Care Unit (ICU) in Tanzania.Methods and FindingsProspective, before-and-after interventional study in the ICU of a university hospital in Tanzania. A context-appropriate protocol that defined danger levels of severely abnormal vital signs and stipulated acute treatment responses was implemented in a four week period using sensitisation, training, job aids, supervision and feedback. Acute treatment of danger signs at admission and during care in the ICU and in-hospital mortality were compared pre and post-implementation using regression models. Danger signs from 447 patients were included: 269 pre-implementation and 178 post-implementation. Acute treatment of danger signs was higher post-implementation (at admission: 72.9% vs 23.1%, p