护士实施胸部超声对成人重症监护病房患者管理的影响：一项前瞻性观察研究。
Effects of nurse delivered thoracic ultrasound on management of adult intensive care unit patients: A prospective observational study.
作者信息
Smits Thomas, Heldeweg Micah, Tulleken Amy Morreale, Verlaan Brian, Floor Lonneke, Eijsenga Alwin, Lust Erik, Gelissen Harry, Girbes Armand, Elbers Paul, Tuinman Pieter Roel
机构信息
Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands.
Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Location: VUmc. De Boelelaan 1118, Amsterdam, 1081 HZ, the Netherlands.
出版信息
Int J Nurs Stud Adv. 2023 May 29;5:100135. doi: 10.1016/j.ijnsa.2023.100135. eCollection 2023 Dec.
BACKGROUND
Thoracic ultrasound is a valuable tool that helps diagnose cardiopulmonary disorders and guide management in intensive care unit patients. Intensive care unit nurses were trained to perform thoracic ultrasound examinations, after which they were named 'UltraNurses' for clinical recognizability. UltraNurses demonstrated rapid learning trajectories, but the impact on clinical-decision making remained unknown. The aim of this study was to investigate the effects of UltraNurse ultrasound on clinical management.
METHODS
This was a prospective observational single center study within a mixed medical and surgical intensive care unit. All adult patients with an indication for UltraNurse thoracic ultrasound were included. The study consisted of three steps: pre- and post- data collection, with the ultrasound examination conducted in-between these two steps. The examination consisted of a standardized ultrasound protocol aimed at the lungs and cardiac output. Primary outcome was what percentage of ultrasounds led to a change of management. Secondary outcomes included: percentage of changes executed within first 8 hours, frequency of pathology found, percentage of diagnosis change, and frequency of UltraNurse ultrasounds per shift.
RESULTS
A total of 102 ultrasound examinations were performed in 65 patients (89% mechanically-ventilated). Ultrasound examinations suggested changes of management in 26% of cases, of which 96% were executed within 8 hours. Most changes were within the nursing scope (56%), specifically: 44% of examinations changed fluid management. UltraNurse ultrasound detected pathology in 97% of cases. In 7% of cases, the diagnosis was changed, sometimes leading to life-saving interventions. UltraNurses performed one thoracic ultrasound examination per four shifts.
CONCLUSION
In adult intensive care unit patients, UltraNurse thoracic ultrasound led to a change of management in more than a quarter of the cases, of which almost all were executed within the first 8 hours.
STUDY REGISTRATION
Netherlands Trial Registration NL9047, VUmc 2020.011 (prospectively registered on: 13-11-2020).
背景
胸部超声是一种有价值的工具，有助于诊断心肺疾病并指导重症监护病房患者的管理。对重症监护病房护士进行了胸部超声检查培训，之后他们被称为“超声护士”以便于临床识别。超声护士展现出快速的学习轨迹，但对临床决策的影响仍不明确。本研究的目的是调查超声护士进行的超声检查对临床管理的影响。
方法
这是一项在综合性内科和外科重症监护病房内进行的前瞻性观察性单中心研究。纳入所有有指征接受超声护士胸部超声检查的成年患者。该研究包括三个步骤：数据收集前和收集后，在这两个步骤之间进行超声检查。检查包括针对肺部和心输出量的标准化超声方案。主要结局是超声检查导致管理改变所占比例。次要结局包括：在最初8小时内执行改变的比例、发现病变的频率、诊断改变的比例以及每班超声护士进行超声检查 的频率。
结果
共对65例患者进行了102次超声检查（89%为机械通气患者）。超声检查提示26%的病例管理需要改变，其中96%在8小时内执行。大多数改变在护理范围内（56%），具体而言：44%的检查改变了液体管理。超声护士进行的超声检查在97%的病例中检测到病变情况。在7%的病例中，诊断发生了改变，有时会带来挽救生命的干预措施。超声护士每四个班次进行一次胸部超声检查.
结论
在成年重症监护病房患者中，超声护士进行的胸部超声检查导致超过四分之一的病例管理发生改变，其中几乎所有改变都在最初8小时内执行.
研究注册
荷兰试验注册编号NL9047，阿姆斯特丹自由大学医学中心2020.011（于2020年11月13日前瞻性注册）
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