Integration of Non-Invasive Cardiac Output Monitor (NICOM) into the Management of Septic Patients
Başlık:
Integration of Non-Invasive Cardiac Output Monitor (NICOM) into the Management of Septic Patients
Yazar:
Talley, Elaine Lim, author.
ISBN:
9780355967821
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (41 pages)
Genel Not:
Source: Masters Abstracts International, Volume: 57-06M(E).
Advisors: Tae Youn Kim Committee members: Kupiri Ackerman-Barger; Deborah Ward.
Özet:
Abstract.
Background: Sepsis management requires ongoing hemodynamic monitoring in the effort to maintain critical tissue perfusion. Although the Non-Invasive Cardiac Output Monitor (NICOM) is considered an aid to clinician assessment of patients’ hemodynamic status, the application of NICOM use in sepsis management in clinical practice is scarce in the literature.
Purpose: The purpose of this quality improvement project was to examine the clinical application of the NICOM in critically ill septic patients and explore variations in outcomes between patients who received care with NICOM and patients with usual care (UC).
Methods: This study involved a retrospective secondary analysis of electronic health records retrieved from the clinical data repository along with manual chart review. This included adult patients (>17 years old) who were admitted to intensive care units (ICU) between July 1, 2016 and June 30, 2017 and had a diagnosis of sepsis, severe sepsis, or septic shock together with serum lactate levels. Descriptive and bivariate statistical analyses were performed, including chi-square, Fisher’s exact, and independent t-tests.
Results: Of the 205 sepsis patients included, there were 131 UC patients and 74 NICOM patients. There was no difference in demographics or comorbidities between the two groups, with the exception of a higher prevalence of hyperlipidemia and a more advanced age (67.1 ± 13.4 versus 61.6 ± 17.4 years) in the NICOM group. Overall the NICOM group was sicker according to the Acute Physiology And Chronic Health Evaluation (APACHE) IVa scores and initial/peak lactate levels, and stayed longer in the ICU (p < .01) along with the higher incidence of vasopressor and mechanical ventilator use (p < .001). Importantly, there was no difference in length of hospital stay and discharge disposition between the two groups according to bivariate analysis.
Conclusions: Interpretations of findings require caution due to the nature of retrospective secondary data analysis of existing records and statistical methods adopted. However, potential benefits of NICOM use were suggested as this NICOM group, who displayed a higher incidence of severe sepsis, presented variations in patient outcomes similar to those of the usual care group. Multivariate analysis is required to examine any association between the NICOM use and improved patient outcomes while controlling confounding variables.
Notlar:
School code: 0029
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(688674.1) | 688674-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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