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对成人护理院部门成人窒息紧急情况中使用的气道清理装置(ACD)DeChoker的评估:一项混合方法案例研究。

Evaluation of DeChoker, an Airway Clearance Device (ACD) Used in Adult Choking Emergencies Within the Adult Care Home Sector: A Mixed Methods Case Study.

作者信息

Bhanderi Bhavik G, Palmer Hill Sue

机构信息

Innovation and Research, Northamptonshire Healthcare NHS Foundation Trust, Berrywood Hospital, Northampton, United Kingdom.

出版信息

Front Public Health. 2020 Dec 9;8:541885. doi: 10.3389/fpubh.2020.541885. eCollection 2020.

Abstract

Foreign Body Airway Obstruction (FBAO) is a medical emergency that can result in death, particularly if swift, appropriate action is not taken. It can be a frightening experience for all involved. DeChoker, an Airway Clearance Device (ACD), might provide an additional alternative in the management of choking; however, limited evidence around its safety and effectiveness makes adoption controversial. An independent evaluation to explore the experiences of health and care professionals who used DeChoker in real-life adult choking emergencies, focusing on the product's safety, efficacy and ease of application. Retrospective mixed methods case study, with multiple embedded units of analysis. UK adult care homes. Twenty seven incidents of adult choking emergencies self-reported by care home staff where DeChoker was used. This data was augmented by an in-depth exploration of four individual choking incidences. The choking victim's ages range: 45 to 101 years (mean 79.8 years). The device was reported to have successfully removed the obstruction in 26 of 27 cases, with very few complications or adverse events reported. In 21 of 27 incidents (78%) the victim was not required to visit Accident and Emergency. Qualitative data indicated nursing home staff found the DeChoker easy to use and valued its presence as an adjunct to current guideline procedures. There is a dearth of evidence surrounding the management of choking and little innovation in this area for five decades. This retrospective evaluation contributes to discussion regarding the role ACDs might play in the management of choking, particularly in cases where current choking management guidance are ineffective, insufficient, inappropriate or impractical (e.g., frail or movement restricted people). The interview data presents a view from care home staff that the DeChoker, as an ACD, contributed to saving the life of choking victims.

摘要

异物气道梗阻(FBAO)是一种医疗急症,可能导致死亡,尤其是在未迅速采取适当措施的情况下。这对所有相关人员来说可能是一次可怕的经历。DeChoker是一种气道清理装置(ACD),在窒息管理方面可能提供了另一种选择;然而,关于其安全性和有效性的证据有限,这使得其应用存在争议。一项独立评估旨在探索在现实生活中的成人窒息紧急情况中使用DeChoker的健康和护理专业人员的经验,重点关注该产品的安全性、有效性和易用性。采用回顾性混合方法案例研究,包含多个嵌入式分析单元。研究对象为英国的成人护理院。护理院工作人员自行报告了27起使用DeChoker的成人窒息紧急事件。通过对四起个别窒息事件的深入探究,补充了这些数据。窒息受害者的年龄范围为45至101岁(平均79.8岁)。据报告,该装置在27例中的26例成功清除了梗阻,报告的并发症或不良事件极少。在27起事件中的21起(78%),受害者无需前往急诊室。定性数据表明,养老院工作人员发现DeChoker易于使用,并重视其作为当前指南程序辅助工具的存在。关于窒息管理的证据匮乏,且该领域在过去五十年中几乎没有创新。这项回顾性评估有助于讨论ACD在窒息管理中可能发挥的作用,特别是在当前窒息管理指南无效、不足、不适用或不切实际的情况下(例如,体弱或行动受限的人群)。访谈数据呈现了养老院工作人员的观点,即DeChoker作为一种ACD有助于挽救窒息受害者的生命。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17b2/7793855/95b3a0a26da8/fpubh-08-541885-g0001.jpg

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