Ramsingh Davinder, Singh Sumit, Canales Cecilia, Guran Elyse, Taylor Zach, Antongiorgi Zarah, Cannesson Maxime, Martin Robert
Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
J Clin Med. 2021 May 28;10(11):2389. doi: 10.3390/jcm10112389.
Point-of-care ultrasound (POCUS) is the most rapidly growing imaging modality for acute care. Despite increased use, there is still wide variability and less evidence regarding its clinical utility for the perioperative setting compared to other acute care settings. This study sought to demonstrate the impact of POCUS examinations for acute hypoxia and hypotension occurring in the post-anesthesia care unit (PACU) versus traditional bedside examinations.
This study was designed as a multi-center prospective observational study. Adult patients who experienced a reduced mean arterial blood pressure (MAP < 60mmHG) and/or a reduced oxygen saturation (SpO2 < 88%) in the PACU from 7AM to 4PM were targeted. POCUS was available or not for patient assessment based on PACU team training. All providers who performed POCUS exams received standardized training on cardiac and pulmonary POCUS. All POCUS exam findings were recorded on a standardized form and the number of suspected mechanisms to trigger the acute event were captured before and after the POCUS exam. PACU length of stay (minutes) across groups was the primary outcome Results: In total, 128 patients were included in the study, with 92 patients receiving a POCUS exam. Comparison of PACU time between the POCUS group (median = 96.5 min) and no-POCUS groups (median = 120.5 min) demonstrated a reduction for the POCUS group, = 0.019. Hospital length of stay and 30-day hospital readmission did not show a significant difference between groups. Finally, there was a reduction in the number of suspected diagnoses from before to after the POCUS examination for both pulmonary and cardiac exams, -values < 0.001.
Implementation of POCUS for assessment of acute hypotension and hypoxia in the PACU setting is associated with a reduced PACU length of stay and a reduction in suspected number of diagnoses.
即时超声检查（POCUS）是急性护理中发展最为迅速的成像方式。尽管其使用日益增多，但与其他急性护理环境相比，其在围手术期的临床效用仍存在很大差异且证据较少。本研究旨在证明POCUS检查对麻醉后护理单元（PACU）中发生的急性缺氧和低血压的影响，与传统床边检查进行对比。
本研究设计为多中心前瞻性观察性研究。目标为上午7点至下午4点在PACU中平均动脉血压降低（MAP < 60mmHg）和/或氧饱和度降低（SpO2 < 88%）的成年患者。根据PACU团队培训情况，患者评估时可使用或不使用POCUS。所有进行POCUS检查的医护人员都接受了心脏和肺部POCUS的标准化培训。所有POCUS检查结果都记录在标准化表格上，并且在POCUS检查前后记录引发急性事件的疑似机制数量。各小组的PACU住院时间（分钟）是主要结局。结果：本研究共纳入128例患者，其中92例接受了POCUS检查。POCUS组（中位数 = 96.5分钟）和非POCUS组（中位数 = 120.5分钟）的PACU时间比较显示，POCUS组时间缩短，P = 0.019。两组之间的住院时间和30天再入院率没有显著差异。最后，肺部和心脏检查的POCUS检查前后疑似诊断数量均有所减少，P值< 0.001。
在PACU环境中实施POCUS评估急性低血压和缺氧与PACU住院时间缩短以及疑似诊断数量减少相关。
