Tang Xiao, Sun Bing, Yang Yuanhua, Tong Zhaohui
Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China.
PLoS One. 2015 Sep 29;10(9):e0139162. doi: 10.1371/journal.pone.0139162. eCollection 2015.
Guideline concordance for venous thromboembolism (VTE) prophylaxis in critically ill patients in intensive care units (ICUs) varies across different countries.
To explore how the medical staff of ICUs in China comprehend and practice VTE prophylaxis.
Questionnaires comprising 39 questions and including 4 dimensions of thromboprophylaxis were administered in ICUs in North China.
In all, 52 ICUs at 23 tertiary hospitals in 7 Chinese provinces and municipalities were surveyed. A total of 2500 questionnaires were sent, and 1861 were returned, corresponding to a response rate of approximately 74.4%. Of all surveyed medical staff, 36.5% of physicians and 22.2% of nurses were aware of the guidelines in China, and 19.0% of physicians and 9.5% of nurses comprehended the 9th edition of the guidelines of the American College of Chest Physicians (ACCP). Additionally, 37.6% of the medical staff chose a prophylaxis method based on the related guidelines, and 10.3% could demonstrate the exact indication for mechanical pattern application. Worries about skin injury, difficulty with removal and discomfort during mechanical thromboprophylaxis were cited by more than 30% of nurses, which was significantly more frequent than for physicians (graduated compression stockings: 54.3% VS 34.1%, 60.7% VS 49%, and 59.4% VS 54%, p = 0.000; intermittent pneumatic compression: 31% VS 22.2%, 19.2% VS 13.9%, and 37.8% VS 27.2%, p = 0.000).
The knowledge of VTE prophylaxis among the medical staff of ICUs in North China remains limited, which may lead to a lack of standardization of VTE prophylaxis. Strengthened, standardized training may help medical staff to improve their comprehension of the relevant guidelines and may finally reduce the occurrence of VTE in ICUs and improve the prognosis of critically ill patients with VTE.
不同国家重症监护病房(ICU)中重症患者静脉血栓栓塞症(VTE)预防的指南依从性存在差异。
探讨中国ICU医护人员对VTE预防的理解与实践情况。
在中国北方的ICU中发放包含39个问题、涵盖预防血栓形成4个维度的问卷。
共对中国7个省直辖市23家三级医院的52个ICU进行了调查。总共发放2500份问卷,回收1861份,回复率约为74.4%。在所有接受调查的医护人员中,36.5%的医生和22.2%的护士知晓中国的指南,19.0%的医生和9.5%的护士理解美国胸科医师学会(ACCP)第9版指南。此外,37.6%的医护人员根据相关指南选择预防方法,10.3%能够说明机械预防模式的确切适用指征。超过30%的护士提到担心机械性血栓预防过程中的皮肤损伤、去除困难和不适,这一比例显著高于医生(分级加压弹力袜:54.3%对34.1%、60.7%对49%、59.4%对54%,p = 0.000;间歇充气加压:31%对22.2%、19.2%对13.9%、37.8%对27.2%,p = 0.000)。
中国北方ICU医护人员对VTE预防的知识仍然有限,这可能导致VTE预防缺乏标准化。加强标准化培训可能有助于医护人员提高对相关指南的理解,并最终减少ICU中VTE的发生,改善VTE重症患者的预后。