Implementation of Goal-Directed Therapy for Children With Suspected Sepsis in the Emergency Department
Implementation of Goal-Directed Therapy for Children With Suspected Sepsis in the Emergency Department
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DOI：
10.1542/peds.2010-2895
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发表时间：
2011-03-01
期刊：
影响因子：
8
通讯作者：
Patel, Binita
中科院分区：
文献类型：
--
作者：
Cruz, Andrea T.;Perry, Andrew M.;Patel, Binita
背景技术背景：次优的护理儿童感染性休克包括延迟识别和不充分的液体复苏。目的：描述实施急诊科（艾德）协议的承认感染性休克和促进遵守国家治疗guidelines.Patients和方法：根本原因分析和发病率和死亡率会议确定系统的问题与败血症的识别和管理。一组的艾德和重症监护医生会见，以确定障碍，并创建solutions.Results：为了促进败血症识别，一个计算机化的分流系统报警异常的生命体征，然后中毒出现的儿童或儿童在高风险的侵入性感染被放置在复苏室。为了促进及时提供干预措施，招募了额外的护理、呼吸治疗和药房人员。通过注射器输注液体;安排标准化实验室检查和抗生素并优先使用。频繁的生命体征测量和干预记录在图形流程图上，以便于解释对治疗的生理反应。方案启动后，167例患者中有191例疑似败血症。与方案实施前的儿童相比，从分诊到首次推注的时间从中位数56分钟缩短到22分钟（P <0.001），第一种抗生素的分诊时间从中位数130分钟减少到38分钟。结论：该方案导致早期识别疑似脓毒症，并大大缩短了至收到时间的时间-敏感的干预措施和治疗变异的减少。儿科2011;127：e758-e766
BACKGROUND: Suboptimal care for children with septic shock includes delayed recognition and inadequate fluid resuscitation.OBJECTIVE: To describe the implementation of an emergency department (ED) protocol for the recognition of septic shock and facilitate adherence to national treatment guidelines.PATIENTS AND METHODS: Root-cause analyses and morbidity and mortality conferences identified system problems with sepsis recognition and management. A group of ED and critical care physicians met to identify barriers and create solutions.RESULTS: To facilitate sepsis recognition, a computerized triage system alarmed on abnormal vital signs, and then toxic-appearing children or children at high risk for invasive infection were placed in a resuscitation room. To facilitate timely delivery of interventions, additional nursing, respiratory therapy, and pharmacy personnel were recruited. Fluids were administered via syringe delivery; standardized laboratory studies and antibiotics were ordered and prioritized. Frequent vital-sign measurements and interventions were documented on a graphical flow sheet to facilitate interpretation of physiologic response to therapy. After protocol initiation, there were 191 encounters in 167 patients with suspected sepsis. When compared with children seen before the protocol, time from triage to first bolus decreased from a median of 56 to 22 minutes (P < .001) and triage to first antibiotics decreased from a median of 130 to 38 minutes (P < .001).CONCLUSIONS: The protocol resulted in earlier recognition of suspected sepsis and substantial reductions in both time to receipt of time-sensitive interventions and a decrement in treatment variation. Pediatrics 2011;127:e758-e766