Gillmann Hans-Jörg, Wasilenko Sascha, Züger Jonathan, Petersen Antje, Klemann Anna, Leffler Andreas, Stueber Thomas
Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
Arch Med Sci. 2019 Mar;15(2):408-415. doi: 10.5114/aoms.2019.83293. Epub 2019 Mar 4.
Despite comprehensive guidelines with high-grade evidence, postoperative nausea and vomiting (PONV) remains a frequent problem in anaesthesia care. Anaesthesia information management systems (AIMS) may aid clinicians in PONV prevention, but their benefit is critically dependent on the details of implementation into practice. This study aimed to examine strengths and weaknesses of the local AIMS-based algorithm in prevention of PONV.
This retrospective study was conducted in the post-anaesthesia care unit (PACU) of a university hospital and included 10 604 patients aged 18 or older who were followed up in the PACU (intracranial, obstetrical or cardiothoracic surgery excluded) from March 2013 until March 2014. The PONV incidence in PACU and AIMS data validity were analysed.
Adherence to PONV guideline recommendations was considerably low, with only 5749 (54%) of the patients receiving correct PONV prophylaxis. Two thousand seven hundred sixty-six (26%) of the patients received an insufficient PONV prophylaxis, which was associated with an excess PONV incidence (11% vs. 4% with correct prophylaxis, < 0.001) in the PACU. Two thousand four hundred forty-nine (23%) of all patients were discharged from the PACU with an insufficient PONV prophylaxis despite perioperative digital PONV prevention algorithms.
Adherence to PONV prophylaxis guidelines in the era of AIMS software and decision support is still remarkably low. The AIMS data usefulness depends on the user, the type of data input and the configuration of the software. Adherence to correct PONV prophylaxis should be re-evaluated systematically before discharge from PACU.
尽管有基于高级别证据的全面指南，但术后恶心呕吐（PONV）仍是麻醉护理中常见的问题。麻醉信息管理系统（AIMS）可能有助于临床医生预防PONV，但其益处严重依赖于在实际应用中的实施细节。本研究旨在探讨基于本地AIMS的算法在预防PONV方面的优缺点。
本回顾性研究在一所大学医院的麻醉后护理单元（PACU）进行，纳入了2013年3月至2014年3月在PACU接受随访的10604例18岁及以上患者（排除颅内、产科或心胸外科手术患者）。分析了PACU中的PONV发生率和AIMS数据的有效性。
对PONV指南建议的依从性相当低，只有5749例（54%）患者接受了正确的PONV预防措施。2766例（26%）患者接受的PONV预防措施不足，这与PACU中PONV发生率过高相关（正确预防措施组为4%，不足预防措施组为11%，<0.001）。尽管有围手术期数字PONV预防算法，但所有患者中有2449例（23%）从PACU出院时PONV预防措施不足。
在AIMS软件和决策支持时代，对PONV预防指南的依从性仍然非常低。AIMS数据的有用性取决于用户、数据输入类型和软件配置。在从PACU出院前，应系统地重新评估对正确PONV预防措施的依从性。
