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，Anesth Analg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。R：S SPECIAL ARTICLEPerioperative Patients With Hemodynamic Instability: Consensus Recommendations of the AnesthesiaPatient Safety Foundation? Michael J. Scott, MB, ChB,*f and the APSF Hemodynamic Instability Writing GroupI In November of 2022, the Anesthesia Patient Safety Foundation held a Consensus Conference on Hemodynamic Instability with invited experts. The objective was to review the science and use expert consensus to produce best practice recommendations to address the issue of perioperative hemodynamic instability. After expert presentations, a modified Delphi process using discussions, voting, and feedback resulted in 17 recommendations regarding advancing the perioperative care of the patient at risk of, or with, hemodynamic instability. There were 17 high- level recommendations. These recommendations related to the following 7 domains: Current Knowledge (5 statements); Preventing Hemodynamic Instability-Related Harm During All Phases of Care (4 statements); Data-Driven Quality Improvement (3 statements); Informing Patients (2 statements); The Importance of Technology (1 statement); Launch a National Campaign (1 statement); and Advancing the Science (1 statement). A summary of the recommendations is presented in Table 1. (Anesth Analg 2023;XXX:00-Oo)SI2022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Table 1. Summary of Recommendations Regarding Advancing the Perioperative Care of the Patient at Risk oft or With, Hemodynamic InstabilityCurrent knowledge1. All providers need to understand the multifactorial pathophysiology of hemodynamic Instability.2. All providers need to have a clear understanding that early detection, identifying the underlying cause and effective interventions are key to best practice.3. Emphasize the strong association of poor OUtCOmeS with multiple organ systems when hemodynamic instabli occurs during perioperative care.4. Formalize teaching of new types of monitoring, including point of care ultrasound, in postgraduate training programs that enable early detection of hemodynamic instability and precise diagnosis of the underlying cause.5. Teach appropriate management of hemodynamic instability in a logical approach using fti(Jr blood products, Inotropes1 and vasopressors such that treatment most effectively addresses the problem and does not lead to unintended harm.Preventing hemodynamic Instability-related harm during all phases of care6. The system of care should be well integrated with effective handoffs and best practices for identifying and treating the patient at risk for hemodynamic instability.7. Operating room Widespread ability to give rapid IIuM bolus and to assess volume responsiveness using appropriate monitoring. Allow the use of peripheral norepinephrine.8. PACU Abilrty to continue effective monitoring for an extended period, as indicated. Ability to continue vasopressors to maintain hemodynamic goals. Abilrty to triage for appropriate placement and monitoring.9. Post-PACU (floor/higher level of Cafe) Continuation of effective monitoring according to the patient risk, surgical risk, and hemodynamic instability. Triage after SUrgefy to appropriate level of care to allow Identiftcation and early treatment of hemodynamic Instability. Availability of point of care ultrasound.Data-driven quality Improvement10. Actionable data collected from all types of patients, procedures, and treatment areas with feedback to systems and providers to drive quality improvement11. Data llectio< from all types of patients, procedures, and treatment areas to be warehoused in open access for research12. Research funding to run multicenter clinical efficacy studies to reduce hemodynamic instability and individualize hemodynamic goals to determine if harm can be mitigatedInforming patients13. A patient Information campaign to engage patients in their care with emphasis on the informed consents regarding risks of su