Eulmesekian Pablo, Pérez Augusto, Díaz Silvia, Ferrero Mateo
Servicio de Terapia Intensiva del Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires.
Arch Argent Pediatr. 2017 Oct 1;115(5):446-452. doi: 10.5546/aap.2017.eng.446.
The use of checklists to increase adherence to evidence-based practices is not yet widespread in pediatric intensive care units. The objective of this study was to achieve 90% compliance with studied practices using an ad hoc checklist.
Time series quasiexperimental study conducted in ventilated children hospitalized in the pediatric intensive care unit. Studied practices included sedation breaks, plateau pressure ≤ 30 cm H O, fraction of inspired oxygen ≤ 60%, maintenance of headboard at > 30°, chlorhexidine mouthwash, weekly ventilator circuit changes, preference for enteral feeding, reduction in the threshold for blood transfusions (hemoglobin: 7 g/dL), daily consideration of spontaneous breathing trials and central venous catheter removal. The checklist was used during ward rounds by the staff physicians in charge of the pediatric intensive care unit as part of an intervention to increase adherence and as a tracking tool. Each form completed on a daily basis was considered an observation. Observations were classified as defective in the case of non-compliance with one or more items. Adherence (the rate of nondefective units of observation) is summarized in the control chart.
The study period lasted 420 days. A total of 732 patients were hospitalized; 218 underwent mechanical ventilation; 1201 observations were made, and 1191 were included in the study. The control chart with a 14-month time horizon showed increased adherence, a special cause variation pattern in the last 3 months of the study period, and > 90% compliance over the last 2 months.
The implementation of a checklist increased adherence to studied practices and achieved more than 90% compliance over the last 2 months of the study period.
在儿科重症监护病房中，使用检查表来提高对循证实践的依从性尚未广泛普及。本研究的目的是通过使用临时检查表使所研究的实践达到90%的依从率。
在儿科重症监护病房住院的接受机械通气的儿童中进行时间序列准实验研究。所研究的实践包括镇静中断、平台压≤30cmH₂O、吸入氧分数≤60%、床头抬高>30°、洗必泰漱口、每周更换呼吸机回路、优先选择肠内营养、降低输血阈值（血红蛋白：7g/dL）、每日考虑自主呼吸试验以及拔除中心静脉导管。检查表由负责儿科重症监护病房的主治医师在查房期间使用，作为提高依从性的干预措施的一部分以及跟踪工具。每天填写的每份表格视为一次观察。若不符合一项或多项条目，则观察结果分类为有缺陷。依从性（无缺陷观察单元的比例）在控制图中进行总结。
研究期持续420天。共有732名患者住院；218例接受机械通气；进行了1201次观察，其中1191次纳入研究。时间跨度为14个月的控制图显示依从性增加，在研究期的最后3个月出现特殊原因变异模式，且在最后2个月依从率>90%。
检查表的实施提高了对所研究实践的依从性，并且在研究期的最后2个月实现了超过90%的依从率。
