Cunningham S, Deere S, Symon A, Elton R A, McIntosh N
Department of Child Life and Health, University of Edinburgh, UK.
Crit Care Med. 1998 Dec;26(12):2053-60. doi: 10.1097/00003246-199812000-00040.
To assess whether the provision of computerized physiologic trend data could improve outcome in newborn infants requiring intensive care.
Randomized, controlled trial, with subsidiary questionnaire studies.
Tertiary neonatal intensive care unit with 12 intensive care cots.
All infants admitted between January 1991 and September 1993 who were < or =32 wks gestation or >32 wks gestation, and ventilated for >4 hrs or asphyxiated.
Randomization to one of four groups for first 7 days of life: A) no display of trend data; B) continuous display of trend data; C1) alternating 24-hr display of trend data, starting with display in first 24 hrs; and C2) alternating 24-hr display of trend data, starting with no display in first 24 hrs.
The short-term effects of monitoring on patient outcome was judged by volume of colloid given, number of blood gases taken, and by measurement taken from cranial Doppler ultrasound. Medium-term measures included time ventilated, time given supplemental oxygen, death, time to death or discharge, and cranial ultrasound at discharge. Long-term outcome was assessed by neurodevelopmental status at age 1 to 4 yrs of age. Staff and parent questionnaires assessed their respective attitudes to the introduction of this technology. None of the patient outcome measures, short-, medium-, or long-term, demonstrated any significant benefit from the provision of computerized physiologic trend monitoring. Staff questionnaires demonstrated an acceptance of the system and an improved understanding of neonatal physiology as a result of computerized physiologic trends. Parent questionnaires demonstrated increased anxiety caused by the system in 11% of parents, although only 1% of parents continued to have concerns if the system were able to help their child.
A randomized, controlled trial was unable to demonstrate any benefit to patients resulting from the introduction of a computerized physiologic trend monitoring system. Benefits of the system have been recognized, however, in subsidiary studies, staff education, and research studies.
评估提供计算机化生理趋势数据是否能改善需要重症监护的新生儿的预后。
随机对照试验，并辅以问卷调查研究。
拥有12张重症监护床位的三级新生儿重症监护病房。
1991年1月至1993年9月期间收治的所有婴儿，孕周小于或等于32周或大于32周，且机械通气超过4小时或窒息。
在出生后的前7天随机分为四组：A组，不显示趋势数据；B组，持续显示趋势数据；C1组，趋势数据交替24小时显示，从出生后第一个24小时开始显示；C2组，趋势数据交替24小时显示，从出生后第一个24小时不显示开始。
通过给予胶体的量、采集血气的次数以及经颅多普勒超声测量来判断监测对患者预后的短期影响。中期指标包括机械通气时间、吸氧时间、死亡情况、死亡或出院时间以及出院时的颅脑超声检查。长期预后通过1至4岁时的神经发育状况进行评估。医护人员和家长问卷调查评估了他们对引入该技术的各自态度。无论是短期、中期还是长期的患者预后指标，均未显示出提供计算机化生理趋势监测有任何显著益处。医护人员问卷调查显示，由于计算机化生理趋势，他们接受了该系统并对新生儿生理学有了更好的理解。家长问卷调查显示，11%的家长因该系统而焦虑增加，不过如果该系统能够帮助他们的孩子，只有1%的家长仍会担忧。
一项随机对照试验未能证明引入计算机化生理趋势监测系统对患者有任何益处。然而，在辅助研究、医护人员教育和研究性研究中，该系统的益处已得到认可。
