Department of Surgery, Boston University Medical Center, Boston, Massachusetts.
JAMA Surg. 2013 Aug;148(8):740-5. doi: 10.1001/jamasurg.2013.358.
Postoperative pulmonary complications can be a devastating consequence of surgery. Validated strategies to reduce these adverse outcomes are needed.
To design, implement, and determine the efficacy of a suite of interventions for reducing postoperative pulmonary complications.
A before-after trial comparing our National Surgical Quality Improvement Program (NSQIP) pulmonary outcomes before and after implementing I COUGH, a multidisciplinary pulmonary care program.
An urban, academic, safety-net hospital.
All patients who underwent general or vascular surgery at our institution during a 1-year period before and after implementation of I COUGH.
A multidisciplinary team developed a strategy to reduce pulmonary complications based on comprehensive patient and family education and a set of standardized electronic physician orders to specify early postoperative mobilization and pulmonary care. Designated by the acronym I COUGH, the program emphasizes incentive spirometry, coughing and deep breathing, oral care (brushing teeth and using mouthwash twice daily), understanding (patient and family education), getting out of bed at least 3 times daily, and head-of-bed elevation. Nursing and physician education promoted a culture of mobilization and I COUGH interventions. I COUGH was implemented for all general surgery and vascular surgery patients at our institution in August 2010.
The NSQIP-reported incidence and risk-adjusted ratios of postoperative pneumonia and unplanned intubation, which NSQIP reports as observed-expected (OE) ratios for the 1-year period before implementing I COUGH and as odds ratios (ORs, statistically comparable to OE ratios) for the period after its implementation.
Before implementation of I COUGH, our incidence of postoperative pneumonia was 2.6%, falling to 1.6% after its implementation, and risk-adjusted outcomes fell from an OE ratio of 2.13 to an OR of 1.58. The incidence of unplanned intubations was 2.0% before I COUGH and 1.2% after I COUGH, with risk-adjusted outcomes decreasing from an OE ratio of 2.10 to an OR of 1.31.
I COUGH, a standardized postoperative care program emphasizing patient education, early mobilization, and pulmonary interventions, reduced the incidence of postoperative pneumonia and unplanned intubation among our patients.
术后肺部并发症可能是手术的灾难性后果。需要验证有效的策略来降低这些不良后果。
设计、实施并确定一套干预措施，以减少术后肺部并发症。
在实施 I COUGH 前后，对我们的国家手术质量改进计划 (NSQIP) 肺部结果进行前后比较的试验。
一个城市、学术、安全网医院。
在我们机构进行一般或血管手术的所有患者，在实施 I COUGH 前后进行了为期一年的研究。
一个多学科团队制定了一项基于全面患者和家庭教育以及一套标准化电子医生医嘱的策略，以指定术后早期动员和肺部护理。该计划以 I COUGH 命名，强调激励式肺活量计、咳嗽和深呼吸、口腔护理（每天刷牙和使用漱口水两次）、理解（患者和家庭教育）、每天至少起床 3 次以及床头抬高。护理和医生教育促进了动员和 I COUGH 干预的文化。2010 年 8 月，我们机构所有普通外科和血管外科患者均实施 I COUGH。
NSQIP 报告的术后肺炎和计划外插管的发生率和风险调整比值，NSQIP 在实施 I COUGH 之前的一年报告为观察到的预期 (OE) 比值，在实施之后的比值为比值比 (OR，与 OE 比值统计学可比)。
在实施 I COUGH 之前，我们的术后肺炎发生率为 2.6%，实施后降至 1.6%，风险调整结果从 OE 比值 2.13 降至 OR 1.58。计划外插管的发生率在 I COUGH 之前为 2.0%，在 I COUGH 之后为 1.2%，风险调整结果从 OE 比值 2.10 降至 OR 1.31。
I COUGH 是一项标准化的术后护理计划，强调患者教育、早期动员和肺部干预，降低了我们患者术后肺炎和计划外插管的发生率。
