U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA.
Crit Care Med. 2011 Sep;39(9):2031-8. doi: 10.1097/CCM.0b013e31821cb790.
Several formulas have been developed to guide resuscitation in severely burned patients during the initial 48 hrs after injury. These approaches require manual titration of fluid that may result in human error during this process and lead to suboptimal outcomes. The goal of this study was to analyze the efficacy of a computerized open-loop decision support system for burn resuscitation compared to historical controls.
Fluid infusion rates and urinary output from 39 severely burned patients with >20% total body surface area burns were recorded upon admission (Model group). A fluid-response model based on these data was developed and incorporated into a computerized open-loop algorithm and computer decision support system. The computer decision support system was used to resuscitate 32 subsequent patients with severe burns (computer decision support system group) and compared with the Model group.
Burn intensive care unit of a metropolitan Level 1 Trauma center.
Acute burn patients with >20% total body surface area requiring active fluid resuscitation during the initial 24 to 48 hours after burn.
We found no significant difference between the Model and computer decision support system groups in age, total body surface area, or injury mechanism. Total crystalloid volume during the first 48 hrs post burn, total crystalloid intensive care unit volume, and initial 24-hr crystalloid intensive care unit volume were all lower in the computer decision support system group. Infused volume per kilogram body weight (mL/kg) and per percentage burn (mL/kg/total body surface area) were also lower for the computer decision support system group. The number of patients who met hourly urinary output goals was higher in the computer decision support system group.
Implementation of a computer decision support system for burn resuscitation in the intensive care unit resulted in improved fluid management of severely burned patients. All measures of crystalloid fluid volume were reduced while patients were maintained within urinary output targets a higher percentage of the time. The addition of computer decision support system technology improved patient care.
已有多种公式被开发出来，以指导严重烧伤患者在受伤后 48 小时内的复苏。这些方法需要人工滴定液体，这可能导致在这个过程中出现人为错误，并导致结果不理想。本研究的目的是分析与历史对照相比，计算机开环决策支持系统在烧伤复苏中的疗效。
记录了 39 例烧伤面积>20%的严重烧伤患者入院时的液体输注率和尿量（模型组）。基于这些数据开发了一种液体反应模型，并将其纳入计算机开环算法和计算机决策支持系统中。计算机决策支持系统用于治疗 32 例随后的严重烧伤患者（计算机决策支持系统组），并与模型组进行比较。
大都会 1 级创伤中心的烧伤重症监护病房。
烧伤面积>20%的急性烧伤患者，在烧伤后 24 至 48 小时内需要积极液体复苏。
我们发现模型组和计算机决策支持系统组在年龄、总体表面积或损伤机制方面没有显著差异。烧伤后前 48 小时内的总晶体液量、晶体液 ICU 总量和初始 24 小时晶体液 ICU 量均较低，计算机决策支持系统组的每公斤体重输注量（mL/kg）和每烧伤百分比的输注量（mL/kg/总体表面积）也较低。计算机决策支持系统组符合每小时尿量目标的患者人数较高。
在重症监护病房实施烧伤复苏计算机决策支持系统可改善严重烧伤患者的液体管理。在维持尿量目标的同时，所有晶体液量的测量值都降低，而患者的时间百分比更高。计算机决策支持系统技术的增加改善了患者的护理。
