Soler M, Raszynski A, Kandrotas R J, Sussmane J B, Aznavorian R, Wolfsdorf J
Division of Critical Care Medicine, Miami Children's Hospital, FL 33155, USA.
J Crit Care. 1997 Dec;12(4):173-6. doi: 10.1016/s0883-9441(97)90028-9.
The purpose of this article was to compare the safety and patient charges of two postextubation treatment regimens.
Twenty-two pediatric patients, between the ages of 7 months and 13 years, who were mechanically ventilated for less than 5 days were studied in a prospective randomized nonblinded study at a multidisciplinary pediatric intensive care unit. Immediately after extubation all patients received supplemental oxygen, administered via mask or nasal cannulae, at a flow rate or concentration sufficient to maintain the pulse oximetric arterial oxygen saturations > 95%; arterial blood gas analyses were performed at 30 minutes after extubation. The subjects were randomly assigned to one of two protocols. Protocol A (our standard management) consisted of (1) three nebulized albuterol treatments administered 1 hour apart, and (2) a chest radiograph obtained within 60 minutes of extubation. Protocol B included one nebulized albuterol treatment administered immediately after extubation. We measured the heart rate, respiratory rate, and arterial blood pressure immediately after and at 60, 120, and 180 minutes following extubation. The following data were also recorded: arterial blood gas analysis results and continuous pulse oximetric arterial oxygen saturation levels. Any significant complications, such as stridor, respiratory distress, or requirement for reintubation, were noted if they occurred within 24 hours of extubation. Patient charge costs were calculated after obtaining the prevailing hospital and physician charges at the time of the study.
Eleven patients completed each arm of the study (total = 22). There were no statistically significant differences between the two groups with respect to arterial pH, serum bicarbonate, pulse oximetric arterial oxygen saturation, arterial blood pressure, respiratory rate, or heart rate (P > .05). Patients treated with Protocol A had a statistically, but not clinically, significant higher mean PaO2 and PaCO2 (P = .02 and P = .05, respectively) than those in Protocol B. Associated charges per patient for Protocol A were $863.50 versus $476.00 for Protocol B. This is a savings of $387.50 per patient. Our pediatric intensive care unit provides care to over 600 intubated patients per year, which would equate to a charge savings of $232,500.00 per year.
A modified postextubation management protocol, consisting of fewer interventions, resulted in significant patient charge savings with no increased risk to the patient.
本文旨在比较两种拔管后治疗方案的安全性及患者费用。
在一家多学科儿科重症监护病房进行了一项前瞻性随机非盲研究，研究对象为22例年龄在7个月至13岁之间、机械通气时间少于5天的儿科患者。拔管后立即为所有患者通过面罩或鼻导管给予补充氧气，流速或浓度足以维持脉搏血氧饱和度动脉血氧饱和度>95%；拔管后30分钟进行动脉血气分析。将受试者随机分配至两种方案之一。方案A（我们的标准管理方案）包括：（1）每隔1小时进行3次雾化沙丁胺醇治疗；（2）拔管后60分钟内进行胸部X光检查。方案B包括拔管后立即进行1次雾化沙丁胺醇治疗。我们在拔管后即刻以及拔管后60、120和180分钟测量心率、呼吸频率和动脉血压。还记录了以下数据：动脉血气分析结果以及连续的脉搏血氧饱和度动脉血氧饱和度水平。如果在拔管后24小时内出现任何严重并发症，如喘鸣、呼吸窘迫或再次插管需求，则予以记录。在获取研究当时现行的医院和医生收费后计算患者费用。
每组各有11例患者完成研究（共22例）。两组在动脉pH值、血清碳酸氢盐、脉搏血氧饱和度动脉血氧饱和度、动脉血压、呼吸频率或心率方面无统计学显著差异（P>.05）。接受方案A治疗的患者平均PaO2和PaCO2在统计学上显著高于方案B组，但无临床显著差异（分别为P = .02和P = .05）。方案A的每位患者相关费用为863.50美元，而方案B为476.00美元。每位患者节省387.50美元。我们的儿科重症监护病房每年为600多名插管患者提供护理，这相当于每年节省费用232,500.00美元。
一种改良的拔管后管理方案，干预措施较少，可显著节省患者费用，且不会增加患者风险。
