最新：围手术期血流动力学不稳定患者的共识建议.docx

最新：围手术期血流动力学不稳定患者的共识建议2022年11月，麻醉患者安全基金会邀请专家召开血流动力学不稳定共识会议。会议的目的进行科学的回顾，并利用专家共识提出最佳实践建议,以解决围手术期血流动力学不稳定的问题。在专家报告后，通过讨论、投票和反馈，并根据改良Delphi程序产生了关于推进存在血流动力学不稳定风险患者的围手术期管理的17项建议。这些建议涉及7个领域:知识现状(5项)，全程预防血流动力学不稳定的相关损害(4项)，数据驱动的质量改进(3项)，告知患者(2项)，技术的重要性(1项)，发起全国运动(1项)，推进科学技术(1项)。2023年12月28日，AnesthAnalg在线刊发APSF的围手术期血流动力学不稳定患者的共识建议。aSPECIALARTICLEPerioperativePatientsWithHemodynamicInstability:ConsensusRecommendationsoftheAnesthesiaPatientSafetyFoundationMichaelJ.Scott.MB.ChB,ttandtheAPSFHemodynamicInstabilityWritingGroupInNovemberof2022.theAnesthesiaPatientSafetyFoundationheldaConsensusConferenceonHemodynamicInstabilitywithinvitedexperts.Theobjectivewastoreviewthescienceanduseexpertconsensustoproducebestpracticerecommendationstoaddresstheissueofperioperativehemodynamicinstability.Afterexpertpresentations,amodifiedDelphiprocessusingdiscussions,voting,andfeedbackresultedin17recommendationsregardingadvancingtheperioperativecareofth©patientatriskof.orwith,hemodynamicinstability.Therewere17high-levelrecommendations.Theserecommendationsrelatedtothefollowing7domains:CurrentKnowledge(5statements);PreventingHemodynamicInstability-RelatedHarmDuringAllPhasesofCare(4statements):Data-DrivenQualityImprovement(3statements);InformingPatients(2statements):TheImportanceofTechnology(1statement)：LaunchaNationalCampaign(1statement)：andAdvancingth©Science(1statement).AsummaryoftherecommendationsispresentedinTable1.(AnesthAnalg2023;XXX:00-00)2022年11月，麻醉患者安全基金会(APSF)召集专家召开共识会议,讨论血流动力学不稳定的关键问题。会议的首要目标是确定预防血流动力学不稳定危害的最佳实践的共识建议。会议强调了在我们完全理解如何定义患者特异性风险和确定最佳的预防和治疗策略之前，还有许多问题仍有待回答。然而，所有与会者都认为可以改进目前的做法并提高患者安全。所提出的建议旨在协助卫生保健系统和医务人员设计管理方法，推行质量改进举措，并开展研究、发展新知识。鉴于现有的知识差距，这些建议不应被视为绝对标准。会议计划包括：讨论围手术期血流动力学监测和血流动力学不稳定的关键问题，并建立有利于改进和研究的建议。与会者收到了一份建议草案，征求反馈意见。在主题专家提交证据后，分组讨论并进行电子投票。讨论之后，这些小组将他们的共识提交给会议主席进行总结。采用改进后的Delphi程序,经过3轮讨论和投票形成共识。随后对修改后的一系列问题进行了最后一轮投票，根据整个会议的讨论和Delphi程序确定最终共识建议。会议议程讨论了下列主要方面： 问题的范围。 临床医生做出有效临床决策所需的最佳数据。 能够更好地为临床路径和决策提供信息的技术需求和诊断工具。表1概述了这些建议。这些建议适用于整个围手术期管理，包涵涉及7个领域的17项高级别建议:知识现状（5项）,全程预防血流动力学不稳定的相关损害（4项），数据驱动的质量改进（3项），告知患者（2项），技术的重要性（1项）,发起全国运动（1项），推进科学技术（1项）。表1关于推进存在血流动力学不稳定风险或伴有血流动力学不稳定的患者围手术期管理的建议摘要Table1.SummaryofRecommendationsRegardingAdvancingthePerioperatlveCareofthePatientatRisko,OrWith,HemOdynarnICInstabilityCurrentknowiedge1. AllPfovxtefSneedtoUMerStandthemultifactorialPathOPh)rsi%yofhemodynamicinstabUty.2. AJlprovidersneedtohaveaclearUndefstandingthatearlydetection,identifyingtheunderlyingcauseandeffectiveinterventionsarekeytobestpractice.3. EmphasizethestrongassociationofPoOroutcomesWlthmuibpieorgansystemswhenhemodynamicInstaMityoccursduringPehoPefa(JVecare.4. Focmehzeteachingofnewtypesofmohoft,mcucngPOtnCOfCarCultrasound,mPOStlraduatotrainingprogramsthatenableearlydetectionofhemodynamicInstabtMyandprecisediagnosisoftheutx>edyW<cause.5. Teach8prortatemftnatefneto(hemodynamicinstabntyMalogicalapproachuscfluid,WOOdproducts,notroes.andvasopressorssuchthattreatmentmostelfectfvetyaddressestheproblemanddoesrMleadtoUrMnWndedharm.PreventinghemodynamicInstabilttyetetedharmClUrlntallphasesofcar6. Tesystemofcareshouldbewe<lintegratedvwtefTectivehandoffsandbestpracticesforBentjfyGgdtreatingthepatientMriskfc>chemodynamictnstabihty.7. Operatingroom WidespreadQittytogivera<xdHuidbolusandtoassessvolumere$pon$tvene$usingappropnatemonitohng, Allowtheuseofperipheralnorepinephrine.8. PACU Abilitytocontinueeffectivemcxctogforanextendedpe11od.asirx>catcd. AbilitytocontinuevesopressorstomarKainhemodynamicfiools. AbilitytoIhaetf,°rappropriateplacementandmonitoring.9. POsIMeU(floor/hieflevelofCafe) Continuationofeffect»vemonttortngaccordingtothepatientrtsKsu<glclrtsk.andhemodynamicinstat)4<ty. Trta(toaftersurgerytoappror¼tolevelofOketoallowkJentcat>onandearlytreatmwxofhomodynamicInstability. Availabilityo(pomtofBrOUnrgOund.DeUHJrtvenquaHtyImprovefnent10. ActionabledataColIeaedfromalltypesofPMtefu9.procedures,andIreetmemareasw<feedbecktosystemsandpcvtderstodriveQualityIrnPrVvement11. QatacollectionfromalltypesofM>tients.procedures,andtreatmentareastobewarehousedinopenaccessforresearch12. ResearchfundingtorunmuiticenierclinicalefcacystMestoreducehemodynamicInsUMtyandindividualizehemodynamicgoalstodetermineifharmcanbemitigatedInfofmlng>atl<ts13. Aat>entInformationcampaigntoOngagepatternsintlrcorewitemphasisontheInlormedconsentsregardingrisksofsurgery14. Beforedischargeupdatingthepaemofanydownstreamrisksofhemodynamicstab<ktyTheImpoctanceoftechnology15. Fasttradenewtecotog)esandtherapiestoacce*erateadoptionandmtegraoonintocurrentpractice.Speaneatty: Improveandimplcentcontinuousnonivasivemonitoring. Improvemonitorsthatproviderealtimeedbocfcastowhetheraninterventioniseffective. EncouragemonitoringthatnotonlyprovidesearlydetectionbutMeellypredictshemodynamicinslabihty. Monitorsthataremorepreciseregardingorganpedsk>nandareIfXlMdudkzedforagivenpatient. AdvanceweaftHeIechnoJogy.Oea<6