Bose Eliezer, Hoffman Leslie, Hravnak Marilyn
School of Nursing, University of Pittsburgh, 3500 Victoria St., 336 Victoria Building, Pittsburgh, PA 15261, USA.
Intensive Crit Care Nurs. 2016 Jun;34:73-80. doi: 10.1016/j.iccn.2015.11.005. Epub 2016 Feb 28.
Unrecognised in-hospital cardiorespiratory instability (CRI) risks adverse patient outcomes. Although step down unit (SDU) patients have continuous non-invasive physiologic monitoring of vital signs and a ratio of one nurse to four to six patients, detection of CRI is still suboptimal. Telemedicine provides additional surveillance but, due to high costs and unclear investment returns, is not routinely used in SDUs. Rapid response teams have been tested as possible approaches to support CRI patients outside the intensive care unit with mixed outcomes. Technology-enabled early warning scores, though rigorously studied, may not detect subtle instability. Efforts to utilise nursing intuition as a means to promote early identification of CRI have been explored, but the problem still persists. Monitoring systems hold promise, but nursing surveillance remains the key to reliable early detection and recognition. Research directed towards improving nursing surveillance and facilitating decision-making is needed to ensure safe patient outcomes and prevent CRI.
未被识别的院内心肺功能不稳定（CRI）会给患者带来不良后果。尽管降级护理单元（SDU）的患者生命体征有持续的无创生理监测，且护士与患者的比例为1:4至1:6，但CRI的检测仍不理想。远程医疗提供了额外的监测，但由于成本高昂且投资回报不明确，在SDU中未被常规使用。快速反应团队已作为在重症监护室外支持CRI患者的可能方法进行了测试，结果不一。基于技术的早期预警评分虽经过严格研究，但可能无法检测到细微的不稳定情况。人们已探索利用护士直觉来促进CRI早期识别的方法，但问题仍然存在。监测系统有前景，但护士监测仍是可靠早期检测和识别的关键。需要开展旨在改善护士监测并促进决策的研究，以确保患者安全并预防CRI。
