麻醉后护理单元低氧血症发作时间分布导致的麻醉医师人员配置考量
Anesthesiologist staffing considerations consequent to the temporal distribution of hypoxemic episodes in the postanesthesia care unit.
作者信息
Epstein Richard H, Dexter Franklin, Lopez Marcos G, Ehrenfeld Jesse M
机构信息
From the *Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; †Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa; ‡Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee; and, §Departments of Anesthesiology, Bioinformatics, Health Policy and Surgery, Vanderbilt University, Nashville, Tennessee.
出版信息
Anesth Analg. 2014 Dec;119(6):1322-33. doi: 10.1213/ANE.0000000000000410.
BACKGROUND
Hypoxemia, as measured by pulse oximetry (SpO2), is common in postanesthesia care unit (PACU) patients. The temporal distribution of desaturation has managerial implications because treatment may necessitate the presence of an anesthesiologist.
METHODS
We retrieved SpO2 values recorded electronically every 30 to 60 seconds from 137,757 PACU patients over n = 80 four-week periods at an academic medical center. Batch mean methods of analysis were used. Onset times of hypoxemic episodes (defined, on the basis of previous studies, as SpO2 <90% lasting at least 2 minutes) were determined and resolution at 3, 5, and 10 minutes was assessed. Episodes beginning <30 minutes and ≥30 minutes after PACU admission were compared. Patients undergoing intubation in the PACU were identified by doing a free text search of electronically recorded nursing notes for phrases suggesting intubation, followed by a confirmatory manual chart review. Intervals from PACU admission to intubation were determined.
RESULTS
Fewer than half (31.2% ± 0.05%) of episodes of PACU hypoxemia lasting ≥2 minutes occurred <30 minutes after PACU admission. Most (i.e., >50%) occurred ≥30 minutes after admission (P < 0.0001). Few (<1%) anesthesia providers transporting patients to the PACU were still present in the PACU 30 minutes after arrival in the PACU. Fewer than half (37%; 95% confidence interval, 27.4% to 48.8%) of PACU intubations occurred <30 minutes after PACU admission. Most (i.e., >50%) occurred ≥30 minutes after admission (P = 0.029). Hypoxemic episodes in the PACU resolved more slowly than episodes in operating rooms (P < 0.0001). After 3 minutes, 40.9% ± 0.6% were unresolved in the PACU versus 23% (99% upper confidence limit) in operating rooms, and 32.6% ± 0.5% vs 9% (99% upper confidence limit) after 5 minutes.
CONCLUSIONS
Because most (68.8%) hypoxemic episodes in the PACU occur ≥30 minutes after admission, a time by which the anesthesia provider who transported the patient usually would no longer be present (>99% of cases), the PACU needs to be considered when anesthesiologist operating room staffing and assignment decisions are made.
背景
通过脉搏血氧饱和度仪（SpO₂）测量的低氧血症在麻醉后护理单元（PACU）患者中很常见。血氧饱和度降低的时间分布具有管理意义，因为治疗可能需要麻醉医生在场。
方法
我们在一所学术医疗中心，从137757例PACU患者在n = 80个为期四周的时间段内，每30至60秒电子记录一次的SpO₂值中进行检索。采用批均值分析方法。确定低氧血症发作的起始时间（根据先前研究定义为SpO₂<90%持续至少2分钟），并评估3分钟、5分钟和10分钟时的缓解情况。比较PACU入院后<30分钟和≥30分钟开始的发作。通过对电子记录的护理记录进行自由文本搜索，查找提示插管的短语，然后进行确认性人工病历审查，来识别在PACU接受插管的患者。确定从PACU入院到插管的时间间隔。
结果
PACU中持续≥2分钟的低氧血症发作中，不到一半（31.2%±0.05%）发生在PACU入院后<30分钟。大多数（即>50%）发生在入院后≥30分钟（P<0.0001）。将患者转运至PACU的麻醉医生在到达PACU 30分钟后仍留在PACU的很少（<1%）。PACU插管中不到一半（37%；95%置信区间，27.4%至48.8%）发生在PACU入院后<30分钟。大多数（即>50%）发生在入院后≥30分钟（P = 0.029）。PACU中的低氧血症发作比手术室中的发作缓解得更慢（P<0.0001）。3分钟后，PACU中有40.9%±0.6%未缓解，而手术室中为23%（99%置信上限）；5分钟后分别为32.6%±0.5%和9%（99%置信上限）。
结论
由于PACU中大多数（68.8%）低氧血症发作发生在入院后≥30分钟，而此时转运患者的麻醉医生通常已不在场（>99%的情况），因此在做出麻醉医生手术室人员配备和任务分配决策时，需要考虑PACU的情况。
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