McRae Jackie, Smith Christina, Beeke Suzanne, Emmanuel Anton
1Division of Medicine, University College London, WC1E 6JF London, UK.
2Speech and Language Therapy Service, London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP London, UK.
Spinal Cord Ser Cases. 2019 Apr 15;5:31. doi: 10.1038/s41394-019-0175-y. eCollection 2019.
A multi-centre online survey to staff working in specialised and non-specialised acute units.
To identify clinical decisions and practices made for acute cervical spinal cord injury (CSCI) patients with respiratory impairments and oropharyngeal dysphagia.
All hospital intensive care units in the UK that admit acute cervical spinal cord injury patients.
Online distribution of a 35-question multiple-choice survey on the clinical management of ventilation, swallowing, nutrition, oral hygiene and communication for CSCI patients, to multi-disciplinary staff based in specialised and non-specialised intensive care units across UK.
Responses were received from 219 staff members based in 92 hospitals. Of the 77 units that admitted CSCI patients, 152 participants worked in non-specialised and 30 in specialised units. Non-specialised unit staff showed variations in clinical decisions for respiratory management compared to specialised units with limited use of vital capacity measures and graduated weaning programme, reliance on coughing to indicate aspiration, inconsistent manipulation of tracheostomy cuffs for speech and swallowing and limited use of instrumental assessments of swallowing. Those in specialised units employed a multi-discplinary approach to clinical management of nutritional needs.
Variation in the clinical management of respiratory impairments and oropharyngeal dysphagia between specialised and non-specialised units have implications for patient outcomes and increase the risk of respiratory complications that impact mortality. The future development of clinical guidance is required to ensure best practice and consistent care across all units.
针对在专科和非专科急症科室工作的人员开展的多中心在线调查。
确定针对患有呼吸功能障碍和口咽吞咽困难的急性颈脊髓损伤（CSCI）患者所做出的临床决策和实践。
英国所有收治急性颈脊髓损伤患者的医院重症监护病房。
向英国各地专科和非专科重症监护病房的多学科工作人员在线发放一份关于CSCI患者通气、吞咽、营养、口腔卫生和沟通临床管理的35道选择题调查问卷。
收到了来自92家医院的219名工作人员的回复。在收治CSCI患者的77个科室中，152名参与者在非专科科室工作，30名在专科科室工作。与专科科室相比，非专科科室工作人员在呼吸管理的临床决策上存在差异，肺活量测量和逐步撤机程序使用有限，依赖咳嗽来指示误吸，气管切开套管用于言语和吞咽的操作不一致，吞咽仪器评估使用有限。专科科室的工作人员采用多学科方法进行营养需求的临床管理。
专科和非专科科室在呼吸功能障碍和口咽吞咽困难的临床管理上存在差异，这对患者预后有影响，并增加了影响死亡率的呼吸并发症风险。需要制定临床指南以确保所有科室的最佳实践和一致护理。
