Hvarfner Anna, Blixt Jonas, Schell Carl Otto, Castegren Markus, Lugazia Edwin R, Mulungu Moses, Litorp Helena, Baker Tim
Medical Faculty, Uppsala University, Uppsala, Sweden.
Mora Hospital, Region Dalarna, Mora, Sweden.
Emerg Med Int. 2020 Jan 7;2020:4819805. doi: 10.1155/2020/4819805. eCollection 2020.
Treating deranged vital signs is a mainstay of critical care throughout the world. In an ICU in a university hospital in Tanzania, the implementation of the Vital Signs Directed Therapy Protocol in 2014 led to an increase in acute treatments for deranged vital signs. The mortality rate for hypotensive patients decreased from 92% to 69%. In this study, the aim was to investigate the sustainability of the implementation two years later. An observational, patient-record-based study was conducted in the ICU in August 2016. Data on deranged vital signs and acute treatments were extracted from the patients' charts. Adherence to the protocol, defined as an acute treatment in the same or subsequent hour following a deranged vital sign, was calculated and compared with before and immediately after implementation. Two-hundred and eighty-nine deranged vital signs were included. Adherence was 29.8% two years after implementation, compared with 16.6% ( < 0.001) immediately after implementation and 2.9% ( < 0.001) before implementation. Consequently, the implementation of the Vital Signs Directed Therapy Protocol appears to have led to a sustainable increase in the treatment of deranged vital signs. The protocol may have potential to improve patient safety in other settings where critically ill patients are managed.
治疗紊乱的生命体征是全球重症监护的主要内容。在坦桑尼亚一家大学医院的重症监护病房，2014年实施的生命体征定向治疗方案导致对紊乱生命体征的急性治疗有所增加。低血压患者的死亡率从92%降至69%。在本研究中，目的是调查两年后该实施方案的可持续性。2016年8月在该重症监护病房进行了一项基于患者记录的观察性研究。从患者病历中提取有关紊乱生命体征和急性治疗的数据。计算对该方案的依从性，定义为在生命体征紊乱后的同一小时或随后一小时内进行急性治疗，并与实施前和实施后立即进行比较。纳入了289例紊乱的生命体征。实施两年后的依从率为29.8%，而实施后立即为16.6%（<0.001），实施前为2.9%（<0.001）。因此，生命体征定向治疗方案的实施似乎导致了对紊乱生命体征治疗的可持续增加。该方案可能有潜力在其他管理重症患者的环境中提高患者安全性。
