University of California - Los Angeles.
University of California - Los Angeles.
J Pediatr Surg. 2020 Jan;55(1):45-48. doi: 10.1016/j.jpedsurg.2019.09.048. Epub 2019 Oct 27.
Our multi-institutional university consortium implemented a gastroschisis pathway in 2015 to standardize and improve care by promoting avoidance of routine intubation and paralysis during silo placement, expeditious abdominal wall closure, discontinuation of antibiotics/narcotics within 48 h of closure, and early initiation/advancement of feeds.
Adherence to the gastroschisis pathway was prospectively monitored. Outcomes for the contemporary cohort (2015-2018) were compared with a historical cohort (2007-2012).
Good adherence to the pathway was observed for 70 cases of inborn uncomplicated gastroschisis. The contemporary cohort had significantly lower median mechanical ventilator days (2 versus 5; p < 0.01) and antibiotic days (5.5 versus 9; p < 0.01) as well as earlier days to initiation of feeds (12 versus 15; p < 0.01). However, no differences were observed in length of stay (28 versus 29 days; p = 0.70). A skin closure technique was performed in 66% of the patients, of which 46% were performed at bedside without intubation, the assistance of an operating-room team, or general anesthesia.
In this study, adherence to a clinical pathway for gastroschisis across different facilities was feasible and led to reduction in exposure to mechanical ventilation and antibiotics. The adoption of a bedside skin closure technique appears to facilitate compliance with the pathway.
Level II/III TYPE OF STUDY: Prospective comparative study with historical cohort.
我们的多机构大学联盟于 2015 年实施了腹裂症治疗路径，通过在造口袋放置时避免常规插管和麻痹、迅速进行腹壁关闭、在关闭后 48 小时内停止使用抗生素/麻醉药以及尽早开始/推进喂养来规范和改善治疗。
前瞻性监测对腹裂症治疗路径的依从性。将当代队列（2015-2018 年）的结果与历史队列（2007-2012 年）进行比较。
对 70 例先天性单纯性腹裂症患者的治疗路径进行了良好的依从。当代队列的机械通气天数（2 天与 5 天；p<0.01）和抗生素使用天数（5.5 天与 9 天；p<0.01）以及开始喂养的天数（12 天与 15 天；p<0.01）均显著降低。然而，两组患者的住院时间无差异（28 天与 29 天；p=0.70）。对 66%的患者采用了皮肤闭合技术，其中 46%在床边进行，无需插管、手术室团队协助或全身麻醉。
在这项研究中，在不同机构中对腹裂症的临床路径进行依从是可行的，可减少机械通气和抗生素的使用。床边皮肤闭合技术的采用似乎有利于对路径的遵守。
II/III 级 研究类型：前瞻性比较研究与历史队列。
