探讨每日目标检查表对小儿心脏重症监护病房(PCICU)先天性心脏病术后住院时间(LOS)的影响。本研究是一项前瞻性随机单中心研究。组特征如下:标准组:n=30,36.7%女性,中位年龄0.9岁;对照组:n=33,36.4%女性,中位年龄1.1岁。有创通气时间,STAT类别,平均血管活性肌力评分(VIS)24h,最大(最大)VIS24h,平均VIS24-48h,max.VIS24-48h,VIS类别,镇静剂的数量,镇痛药,利尿剂,部署的诊断方式的数量,发病率,两组间死亡率无差异.PCICULOS中位数为96.0h(标准组)与101.5h(对照组)(p=0.63)。在整个队列中,单变量回归分析确定手术年龄(b=-0.02),统计类别(b=18.3),冠心病的严重程度(b=40.6),平均VIS24h(b=3.5),max.VIS24h(b=2.2),平均VIS24-48h(b=6.5),和VIS类别(b=13.8)作为延长PCICULOS的重要参数。在多元回归分析中,手术年龄(b=-0.2),冠心病的严重程度(b=44.0),平均VIS24h(b=6.7)有显著性。在标准分组内,单变量回归分析确定STAT类别(b=32.3),冠心病的严重程度(b=70.0),平均VIS24h(b=5.0),平均VIS24-48h(b=5.9),定义的目标数(b=2.6),实现的目标数(b=3.3),未实现的目标数(b=10.8),和未评估的目标数量(b=7.0)作为延长PCICULOS的重要参数。多变量回归分析确定了定义目标的数量(b=2.5)和未评估目标的数量(b=-3.0)是重要参数。结论:通过减少PCICULOS,对儿童心脏手术后患者的每日目标的结构化实现和记录具有优势。已知内容:•通信错误是重症监护病房患者中不良事件的最常见原因。•通过在每日回合中讨论和记录患者的目标,可以实现更好的沟通。新增内容:•在手术的总体队列年龄中,先天性心脏病的严重程度和前24小时内的平均血管活性正性肌力评分对儿科心脏重症监护病房(PCICU)住院时间(LOS)有显著影响.•在干预组中,确定的目标数和未评估的目标数是延长PCICULOS的重要参数.
To explore the effect of a daily goal checklist on pediatric cardiac intensive care unit (PCICU) length of stay (LOS) after congenital heart surgery. This
study is a prospective randomized single-center
study. Group characteristics were as follows: STANDARD group: n = 30, 36.7% female, median age 0.9 years; control group: n = 33, 36.4% female, median age 1.1 years. Invasive ventilation time, STAT categories, mean vasoactive-inotropic score (VIS)24h, maximal (max.) VIS24h, mean VIS24-48h, max. VIS24-48h, VIS category, number of sedatives, analgesics, diuretics, number of deployed diagnostic modalities, morbidities, and mortality did not differ between both groups. Median PCICU LOS was 96.0 h (STANDARD group) versus 101.5 h (control group) (p = 0.63). In the overall cohort, univariate regression analysis identified age at surgery (b = -0.02), STAT category (b = 18.3), severity of CHD (b = 40.6), mean VIS24h (b = 3.5), max. VIS24h (b = 2.2), mean VIS24-48h (b = 6.5), and VIS category (b = 13.8) as significant parameters for prolonged PCICU LOS. In multivariate regression analysis, age at surgery (b = -0.2), severity of CHD (b = 44.0), and mean VIS24h (b = 6.7) were of significance. Within the STANDARD sub-group, univariate regression analysis determined STAT category (b = 32.3), severity of CHD (b = 70.0), mean VIS24h (b = 5.0), mean VIS24-48h (b = 5.9), number of defined goals (b = 2.6), number of achieved goals (b = 3.3), number of not achieved goals (b = 10.8), and number of unevaluated goals (b = 7.0) as significant parameters for prolonged PCICU LOS. Multivariate regression analysis identified the number of defined goals (b = 2.5) and the number of unevaluated goals (b = -3.0) to be significant parameters. Conclusion: The structured realization and recording of daily goals is of advantage in patients following pediatric cardiac surgery by reducing PCICU LOS. What is known: • Communication errors are the most frequent reasons for adverse events in intensive care unit patients. • Improved communication can be achieved by discussion and documentation of the patients\' goals during daily rounds. What is new: • In the overall cohort age at surgery, severity of congenital heart defect and mean vasoactive inotropic score within the first 24 hours had significant impact on pediatric cardiac intensive care unit (PCICU) length of stay (LOS). • In the intervention group, the number of defined goals and the number of unevaluated goals were significant parameters for prolonged PCICU LOS.