Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
Department of Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
Eur J Cardiovasc Nurs. 2023 Mar 1;22(2):175-183. doi: 10.1093/eurjcn/zvac050.
To describe the incidence and impact of adverse clinical events (ACEs) during first 24 h of bedrest of patients after cardiac implantable electronic device (CIED) implantation.
We conducted a prospective observational study of patients aged over 18 years undergoing elective placement of permanent bicameral pacemaker (PM), cardiac resynchronization therapy (CRT) PM, CRT defibrillator, or implantable cardioverter-defibrillator. Patients were maintained on bedrest post-operatively for 24 h and delirium, post-operative urinary retention, severe post-operative pain, pressure ulcer, and sleep disturbance were recorded using standardized assessments. Of 90 patients, 66 (73.3%) were male and average age was 76 ± 10 years. The median time to first mobilization was 23 (21-24) h. The adverse clinical events occurred in 48/90, with severe pain (38/90), sleep disturbance (12/90), delirium (9/90), and urinary retention requiring urinary catheterization (8/90) most frequent. Patients receiving implantable cardioverter-defibrillator or CRT defibrillator experienced ACEs significantly more frequently than those receiving PM. Adverse clinical event was associated with prolonged hospital stay [odds ratio (OR) 2.5; 95% confidence interval (CI) 1.16-6.17]. Patients with delirium were more dependent for daily living activities on admission (OR 8.0; 95% CI 1.55-41.3).
Adverse clinical events frequently occur post-insertion of a CIED and impact patient clinical course and experience. The progressive increase in ageing and frailty of CIED implant candidates requires special nursing attention to improve patients' satisfaction and to prevent increased healthcare resource use.
描述心脏植入式电子设备（CIED）植入后患者卧床休息 24 小时内不良临床事件（ACEs）的发生率和影响。
我们对 18 岁以上接受永久性双腔起搏器（PM）、心脏再同步治疗（CRT）PM、CRT 除颤器或植入式心脏复律除颤器的择期放置患者进行了前瞻性观察研究。患者术后卧床休息 24 小时，并使用标准化评估记录谵妄、术后尿潴留、严重术后疼痛、压疮和睡眠障碍。90 例患者中，66 例（73.3%）为男性，平均年龄 76±10 岁。首次活动的中位时间为 23（21-24）小时。90 例中发生不良临床事件 48 例，其中严重疼痛（38/90）、睡眠障碍（12/90）、谵妄（9/90）和需要导尿的尿潴留（8/90）最常见。植入式心脏复律除颤器或 CRT 除颤器组患者发生 ACEs 的频率明显高于 PM 组。不良临床事件与住院时间延长相关[比值比（OR）2.5；95%置信区间（CI）1.16-6.17]。有谵妄的患者入院时日常生活活动能力更依赖他人（OR 8.0；95%CI 1.55-41.3）。
CIED 植入后常发生不良临床事件，影响患者的临床过程和体验。CIED 植入候选者老龄化和虚弱程度的逐渐增加需要特别的护理关注，以提高患者满意度并防止增加医疗保健资源的使用。
