Hewson-Conroy K M, Burrell A R, Elliott D, Webb S A R, Seppelt I M, Taylor C, Glass P
New South Wales Intensive Care Coordination and Monitoring Unit, Penrith, New South Wales, Australia.
Anaesth Intensive Care. 2011 Sep;39(5):926-35. doi: 10.1177/0310057X1103900520.
There are indications that compliance with routine clinical practices in intensive care units (ICU) varies widely internationally, but it is currently unknown whether this is the case throughout Australia and New Zealand. A one-day point prevalence study measured the prevalence of routine care processes being delivered in Australian and New Zealand ICUs including the assessment and/or management of: nutrition, pain, sedation, weaning from mechanical ventilation, head of bed elevation, deep venous thrombosis prophylaxis, stress ulcer prophylaxis, blood glucose, pressure areas and bowel action. Using a sample of 50 adult ICUs, prevalence data were collected for 662 patients with a median age of 65 years and a median Acute Physiology and Chronic Health Evaluation II score of 18. Wide variations in compliance were evident in several care components including: assessment of nutritional goals (74%, interquartile range [IQR] 51 to 89%), pain score (35%, IQR 17 to 62%), sedation score (89%, IQR 50 to 100%); care of ventilated patients e.g. head of bed elevation > 30 degrees (33%, IQR 7 to 62%) and setting weaning plans (50%, IQR 28 to 78%); pressure area risk assessment (78%, IQR 18 to 100%) and constipation management plan (43%, IQR 6 to 87%). Care components that were delivered more consistently included nutrition delivery (100%, IQR 100 to 100%), deep venous thrombosis (96%, IQR 89 to 100%) and stress ulcer (90%, IQR 78 to 100%) prophylaxis, and checking blood sugar levels (93%, IQR 88 to 100%). This point prevalence study demonstrated variability in the delivery of 'routine' cares in Australian and New Zealand ICUs. This may be driven in part by lack of consensus on what is best practice in intensive care units, prompting the need for further research in this area.
有迹象表明，重症监护病房（ICU）对常规临床实践的遵循情况在国际上差异很大，但目前尚不清楚澳大利亚和新西兰各地是否也是如此。一项为期一天的现况研究测量了澳大利亚和新西兰ICU中常规护理流程的实施情况，包括对以下方面的评估和/或管理：营养、疼痛、镇静、机械通气撤机、床头抬高、深静脉血栓形成预防、应激性溃疡预防、血糖、受压部位和排便情况。以50个成人ICU为样本，收集了662例患者的现况数据，这些患者的中位年龄为65岁，急性生理与慢性健康状况评分II（APACHE II）的中位数为18分。在几个护理环节中，遵循情况存在很大差异，包括：营养目标评估（74%，四分位间距[IQR]为51%至89%）、疼痛评分（35%，IQR为17%至62%）、镇静评分（89%，IQR为50%至100%）；通气患者的护理，如床头抬高>30度（33%，IQR为7%至62%）和制定撤机计划（50%，IQR为28%至78%）；受压部位风险评估（78%，IQR为18%至100%）和便秘管理计划（43%，IQR为6%至87%）。实施更一致的护理环节包括营养供给（100%，IQR为100%至100%）、深静脉血栓形成预防（96%，IQR为89%至100%）和应激性溃疡预防（90%，IQR为78%至100%），以及血糖检测（93%，IQR为88%至100%）。这项现况研究表明，澳大利亚和新西兰ICU中“常规”护理的实施存在差异。这可能部分是由于对重症监护病房最佳实践缺乏共识，因此需要在该领域进行进一步研究。
