急诊科鼻高流量治疗的前瞻性研究

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing Pub Date : 2025-08-05 DOI:10.1016/j.ienj.2025.101660

Jane O’Donnell , Georgia Doyle , Michaela Fletcher , Chantelle Maria Dick

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引用次数: 0

摘要

在全球范围内，急诊科（ED）护士通常护理需要呼吸支持的患者；这种支持可能包括鼻高流量（NHF）治疗。该研究的目的是分析和评估接受NHF呼吸支持的ED患者与接受所有其他形式呼吸支持的患者的结果。方法采用前瞻性、观察性、多中心方法，于2023年4月和5月2个12小时时段，在新西兰4个急诊科采集实时、真实的流行病学数据。N = 898例患者就诊于参与急诊科；少数患者（n = 76, 8.46%）接受了呼吸支持，其中一部分患者（n = 12, 15.7%）接受了NHF。结果接受NHF的患者以男性居多（n = 8, 66%），新西兰欧裔（n = 4, 33%），平均年龄69.91岁（SD 18.93）。这些参与者的平均分诊评分为2.66 (SD 0.65)，平均修正预警评分为7.58 （SD 3.32）。“呼吸”是最常见的参与者诊断类别（n = 5, 41.5%）。提供NHF的最常见原因是“氧合改善”（n = 4, 33.3%）。与接受其他形式呼吸支持的患者相比，接受NHF的患者似乎需要更少的呼吸支持升级（n = 1,8.3%, n = 21,32.8%）。与其他形式的呼吸支持相比，升级至NHF的治疗效果无显著差异（RR 0.31, 95% CI 0.04至2.12,P = 0.23， NNT（获益）5.87,95% CI 2.43至14.07）。入院患者的平均总住院时间为8天（4-15天）。在急诊科接受NHF的患者中，这一比例明显更高（Mann-Whitney U, 183, P = 0.004）。结论鉴于所采用的方法，所有的结果都必须谨慎看待。该研究报告称，少数需要呼吸支持的ED患者接受了NHF。然而，这些患者似乎具有高视力，高住院需求和住院时间（LOS）的增加。总的来说，这些数据表明这些患者是医疗资源的高消费人群。这些新西兰的研究结果可能对整个卫生部门的研究和护理计划产生影响，包括ed对急诊护理实践的贡献。关于这个主题我们已经知道什么？鼻高流量治疗，提供呼吸支持，是在急诊科提供给病人的许多条件。这篇论文对目前发表的文献有何补充？本文对急诊科患者的流行病学描述提供了鼻高流量，可以为未来的急诊科临床实践和研究提供基准。对临床急诊护理实践最重要的启示是什么？本研究中的患者易受伤害，具有高敏锐度，需要有针对性的呼吸支持来改善其预后。

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Nasal high flow therapy in the emergency department – A prospective study

Background

Globally, emergency department (ED) nurses routinely care for patients requiring respiratory support; this support may include nasal high flow (NHF) therapy.

Objective

The study objective was to profile and evaluate the outcomes of ED patients receiving NHF respiratory support compared to those receiving all other forms of respiratory support.

Methods

A prospective, observational, multicenter method was used to capture real-time, real-world epidemiological data at four New Zealand EDs for two 12-hour periods in April and May 2023. N = 898 patients presented to the participating EDs; the minority, n = 76 (8.46 %), received respiratory support, with a subset of these (n = 12, 15.7 %) receiving NHF.

Results

Most of those receiving NHF were male (n = 8, 66 %), of New Zealand European ethnicity (n = 4, 33 %), with a mean age of 69.91 years (SD 18.93). These participants had a mean triage score of 2.66 (SD 0.65) and a mean modified early warning score of 7.58 (SD 3.32). ‘Respiratory’ was the most common participant diagnostic category (n = 5, 41.5 %). The most common reason for NHF delivery was ‘oxygenation improvement’ (n = 4, 33.3 %).

Those receiving NHF appeared to require less escalation of respiratory support versus those receiving other forms of respiratory support (n = 1, 8.3 %, versus n = 21, 32.8 %). No significant difference in treatment effect was seen for escalation to NHF versus other forms of respiratory support (RR 0.31, 95 % CI 0.04 to 2.12, P = 0.23, NNT (benefit) 5.87, 95 % CI 2.43 to 14.07). The median overall length of stay for those admitted to the hospital was eight days (4–15). This was seen to be significantly higher for those receiving NHF in the ED (Mann-Whitney U, 183, P = 0.004).

Conclusion

Given the methods used, all findings must be viewed with caution. The study reports that a minority of ED patients requiring respiratory support receive NHF. However, these patients appear to have high acuities, a high need for hospitalization, and an increased length of stay (LOS). Collectively, these data suggest that these patients are high consumers of healthcare resources. These New Zealand study findings may have implications for research and care planning across health sectors, including the ED.

Contribution to Emergency Nursing Practice

What is already known about this topic? Nasal high-flow therapy, which provides respiratory support, is provided in the emergency department to patients with many conditions.

What does this paper add to the currently published literature? This description of the epidemiology of emergency department patients provided nasal high flow here may inform benchmarking for future ED clinical practice and research.

What is the most important implication for clinical emergency nursing practice? The patients profiled in this study are vulnerable, have high acuity, and require targeted respiratory support to improve their outcomes.

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来源期刊

International Emergency Nursing NURSING-

CiteScore

3.20

自引率

11.10%

发文量

期刊介绍： International Emergency Nursing is a peer-reviewed journal devoted to nurses and other professionals involved in emergency care. It aims to promote excellence through dissemination of high quality research findings, specialist knowledge and discussion of professional issues that reflect the diversity of this field. With an international readership and authorship, it provides a platform for practitioners worldwide to communicate and enhance the evidence-base of emergency care. The journal publishes a broad range of papers, from personal reflection to primary research findings, created by first-time through to reputable authors from a number of disciplines. It brings together research from practice, education, theory, and operational management, relevant to all levels of staff working in emergency care settings worldwide.