Delgado-Corcoran Claudia, Wolpert Katherine H, Lucas Kathryn, Bodily Stephanie, Presson Angela P, Bratton Susan L
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT.2Division of Pediatric Critical Care Medicine, Primary Children's Hospital, Intermountain Health Care, Salt Lake City, UT.
Pediatr Crit Care Med. 2016 Nov;17(11):1055-1063. doi: 10.1097/PCC.0000000000000957.
To determine whether judicious blood testing impacts timing or amount of packed RBC transfusions in infants after heart surgery.
A retrospective study comparing before and after initiation of a quality improvement process.
A university-affiliated cardiac ICU at a tertiary care children's hospital.
Infants less than 1 year old with Risk Adjustment for Congenital Heart Surgery category 4, 5, 6, or d-transposition of great arteries (Risk Adjustment for Congenital Heart Surgery 3) consecutively treated during 2010 through 2013.
A quality improvement process implemented in 2011 to decrease routine laboratory testing after surgery.
Fifty-two infants preintervention and 214 postintervention had similar age, weight, proportion of cyanotic lesions, and surgical complexity. Infants with single versus biventricular physiology were compared separately. The number of laboratory tests per patient adjusted for cardiac ICU length of stay (laboratory tests/patient/day) was significantly lower in postintervention populations for single and biventricular groups (9 vs 15 and 10 vs 15, respectively; p < 0.001). The proportion of single ventricle patients transfused post- and preintervention was not statistically different (72% vs 90%; p = 0.130). Transfusion in the biventricular groups was the same over time (65% vs 65%). Time to first transfusion was significantly longer in the postintervention single ventricle group (4 vs 1 d; p < 0.001), and was not statistically different in the biventricular patients (4 vs 7 d; p = 0.058). The median hematocrit level at first transfusion was significantly lower (37% vs 40%; p = 0.004) postintervention in the cyanotic population, but did not differ in the biventricular group (31% vs 31%; p = 0.840).
In infants after heart surgery, blood testing targeted to individual needs significantly decreased the number of blood tests, but did not significantly decrease postoperative blood transfusion.
确定合理的血液检测是否会影响心脏手术后婴儿输注红细胞悬液的时间或数量。
一项回顾性研究，比较质量改进措施实施前后的情况。
一家三级护理儿童医院的大学附属心脏重症监护病房。
2010年至2013年期间连续接受治疗的1岁以下患有先天性心脏病手术风险调整分类4、5、6或大动脉d型转位（先天性心脏病手术风险调整3）的婴儿。
2011年实施的一项质量改进措施，以减少术后常规实验室检测。
干预前的52名婴儿和干预后的214名婴儿在年龄、体重、青紫病变比例和手术复杂性方面相似。对单心室与双心室生理状态的婴儿分别进行比较。根据心脏重症监护病房住院时间调整后的每位患者的实验室检测次数（实验室检测次数/患者/天），干预后单心室组和双心室组均显著降低（分别为9次对15次和10次对15次；p<0.001）。干预前后单心室患者输血的比例无统计学差异（72%对90%；p=0.130）。双心室组的输血情况随时间保持不变（65%对65%）。干预后单心室组首次输血的时间显著延长（4天对1天；p<0.001），双心室患者则无统计学差异（4天对7天；p=0.058）。青紫人群干预后首次输血时的中位血细胞比容水平显著降低（37%对40%；p=0.004），但双心室组无差异（31%对31%；p=0.840）。
在心脏手术后的婴儿中，针对个体需求的血液检测显著减少了血液检测次数，但未显著减少术后输血。
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