Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.
J Intensive Care Med. 2020 Apr;35(4):371-377. doi: 10.1177/0885066617752659. Epub 2018 Jan 22.
Hypokalemia in children following cardiac surgery occurs frequently, placing them at risk of life-threatening arrhythmias. However, renal insufficiency after cardiopulmonary bypass warrants careful administration of potassium (K). Two different nurse-driven protocols (high dose and tiered dosing) were implemented to identify an optimal K replacement regimen, compared to an historical low-dose protocol. Our objective was to evaluate the safety, efficacy, and timeliness of these protocols.
A retrospective cohort review of pediatric patients placed on intravenous K replacement protocols over 1 year was used to determine efficacy and safety of the protocols. A prospective single-blinded review of K repletion was used to determine timeliness.
Pediatric patients with congenital or acquired cardiac disease.
Twenty-four-bed cardiothoracic intensive care unit in a tertiary children's hospital.
Efficacy was defined as fewer supplemental potassium chloride (KCl) doses, as well as a higher protocol to total doses ratio per patient. Safety was defined as a lower percentage of serum K levels ≥4.8 mEq/L after a dose of KCl. Between-group differences were assessed by nonparametric univariate analysis.
There were 138 patients with a median age of 3.0 (interquartile range: 0.23-10.0) months. The incidence of K levels ≥4.8 mEq/L after a protocol dose was higher in the high-dose protocol versus the tiered-dosing protocol but not different between the low-dose and tiered-dosing protocols (high dose = 2.2% vs tiered dosing = 0.5%, = .05). The ratio of protocol doses to total doses per patient was lower in the low-dose protocol compared to the tiered-dosing protocol ( < .05). Protocol doses were administered 45 minutes faster ( < .001).
The tiered-dosed, nurse-driven K replacement protocol was associated with decreased supplemental K doses without increased risk of hyperkalemia, administering doses faster than individually ordered doses; the protocol was effective, safe, and timely in the treatment of hypokalemia in pediatric patients after cardiac surgery.
小儿心脏手术后常发生低钾血症，使他们有发生危及生命的心律失常的风险。然而，体外循环后肾功能不全需要谨慎给予钾（K）。为了确定最佳的 K 替代方案，实施了两种不同的护士驱动方案（高剂量和分级剂量），与历史上的低剂量方案进行比较。我们的目的是评估这些方案的安全性、疗效和及时性。
回顾性分析了 1 年内接受静脉内 K 替代方案的儿科患者队列，以确定方案的疗效和安全性。前瞻性单盲回顾性评价 K 补充的及时性。
患有先天性或后天性心脏病的儿科患者。
一家三级儿童医院的 24 张床心胸重症监护病房。
疗效定义为补充氯化钾（KCl）剂量减少，以及每个患者的方案剂量与总剂量的比例更高。安全性定义为 KCl 剂量后血清 K 水平≥4.8 mEq/L 的百分比较低。通过非参数单变量分析评估组间差异。
共有 138 名患者，中位年龄为 3.0（四分位距：0.23-10.0）个月。高剂量方案与分级剂量方案相比，方案剂量后 K 水平≥4.8 mEq/L 的发生率较高，但低剂量方案与分级剂量方案之间无差异（高剂量=2.2%比分级剂量=0.5%，=0.05）。与分级剂量方案相比，低剂量方案中每个患者的方案剂量与总剂量的比例较低（<0.05）。方案剂量给药速度快 45 分钟（<0.001）。
分级剂量、护士驱动的 K 替代方案与减少补充 K 剂量相关，而不会增加高钾血症的风险，与单独开的剂量相比，该方案更快地给药；在小儿心脏手术后低钾血症的治疗中，该方案有效、安全且及时。
