自发性幕上脑出血后接受减压开颅术和内镜下血肿清除术的患者的麻醉性能改进和报告交换（ASPIRE）质量指标：一项回顾性观察研究。

IF 2.3 2区医学 Q2 ANESTHESIOLOGY

Journal of neurosurgical anesthesiology Pub Date : 2024-07-01 Epub Date: 2023-03-21 DOI:10.1097/ANA.0000000000000912

Abhijit V Lele, Christine T Fong, Shu-Fang Newman, Vikas O'Reilly-Shah, Andrew M Walters, Umeshkumar Athiraman, Michael J Souter, Michael R Levitt, Monica S Vavilala

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引用次数: 0

摘要

背景：我们报告了与自发性幕上脑出血（sICH）后接受减压颅骨切除术或内镜下血栓清除的患者相关的6项麻醉性能改进和报告交换（ASPIRE）质量指标（QMs）的遵守情况。方法：在这项回顾性观察研究中，我们描述了对以下ASPIRE QMs的依从性：急性肾损伤（AKI-01）；平均动脉压＜65毫米汞柱小于15分钟（BP-03）；心肌损伤（CARD-02）；治疗高糖（>200 mg/dL，GLU-03）；肌松拮抗剂（NMB-02）；结果：该研究包括95名患者（70%男性），中位（四分位间距）年龄55岁（47-66），ICH评分2（1-3），在sICH后接受颅骨切除术（n=55）或内镜下血栓清除术（n=40）。可归因于sICH的住院死亡率为23%（n=22）。美国麻醉师协会身体状况为5级（n=16）、术前肾小球滤过率降低（n=5）、心肌肌钙蛋白升高（n=21）且无术中高血糖实验室（n=71）、病例结束时未拔管（n=62）或未接受神经肌肉阻滞剂治疗（n=3）的患者，并且具有紧急手术的患者（n＝64）基于预定的ASPIRE排除标准从其各自的ASPIREQM的分析中排除。对于其余患者，对ASPIRE QMs的依从性为：AKI-01，颅骨切除术34%，内镜下血栓清除术1%；BP-03，颅骨切除术72%，血栓清除术73%；CARD-02，两组均为100%；GLU-03，颅骨切除67%，血栓清除100%；NMB-02，血栓排空79%，和；TEMP-03，低温时血栓排空0%。结论：本研究发现，在接受颅骨减压或内镜下清除血栓的sICH患者中，ASPIRE QMs的依从性各不相同。被排除在个体ASPIRE指标之外的患者数量相对较高是一个主要限制。

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Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Quality Metrics in Patients Undergoing Decompressive Craniectomy and Endoscopic Clot Evacuation after Spontaneous Supratentorial Intracerebral Hemorrhage: A Retrospective Observational Study.

Background: We report adherence to 6 Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) quality metrics (QMs) relevant to patients undergoing decompressive craniectomy or endoscopic clot evacuation after spontaneous supratentorial intracerebral hemorrhage (sICH).

Methods: In this retrospective observational study, we describe adherence to the following ASPIRE QMs: acute kidney injury (AKI-01); mean arterial pressure < 65 mm Hg for less than 15 minutes (BP-03); myocardial injury (CARD-02); treatment of high glucose (> 200 mg/dL, GLU-03); reversal of neuromuscular blockade (NMB-02); and perioperative hypothermia (TEMP-03).

Result: The study included 95 patients (70% male) with median (interquartile range) age 55 (47 to 66) years and ICH score 2 (1 to 3) undergoing craniectomy (n=55) or endoscopic clot evacuation (n=40) after sICH. In-hospital mortality attributable to sICH was 23% (n=22). Patients with American Society of Anesthesiologists physical status class 5 (n=16), preoperative reduced glomerular filtration rate (n=5), elevated cardiac troponin (n=21) and no intraoperative labs with high glucose (n=71), those who were not extubated at the end of the case (n=62) or did not receive a neuromuscular blocker given (n=3), and patients having emergent surgery (n=64) were excluded from the analysis for their respective ASPIRE QM based on predetermined ASPIRE exclusion criteria. For the remaining patients, the adherence to ASPIRE QMs were: AKI-01, craniectomy 34%, endoscopic clot evacuation 1%; BP-03, craniectomy 72%, clot evacuation 73%; CARD-02, 100% for both groups; GLU-03, craniectomy 67%, clot evacuation 100%; NMB-02, clot evacuation 79%, and; TEMP-03, clot evacuation 0% with hypothermia.

Conclusion: This study found variable adherence to ASPIRE QMs in sICH patients undergoing decompressive craniectomy or endoscopic clot evacuation. The relatively high number of patients excluded from individual ASPIRE metrics is a major limitation.

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来源期刊

Journal of neurosurgical anesthesiology 医学-临床神经学

CiteScore

6.20

自引率

10.80%

发文量

119

审稿时长

>12 weeks

期刊介绍： The Journal of Neurosurgical Anesthesiology (JNA) is a peer-reviewed publication directed to an audience of neuroanesthesiologists, neurosurgeons, neurosurgical monitoring specialists, neurosurgical support staff, and Neurosurgical Intensive Care Unit personnel. The journal publishes original peer-reviewed studies in the form of Clinical Investigations, Laboratory Investigations, Clinical Reports, Review Articles, Journal Club synopses of current literature from related journals, presentation of Points of View on controversial issues, Book Reviews, Correspondence, and Abstracts from affiliated neuroanesthesiology societies. JNA is the Official Journal of the Society for Neuroscience in Anesthesiology and Critical Care, the Neuroanaesthesia and Critical Care Society of Great Britain and Ireland, the Association de Neuro-Anesthésiologie Réanimation de langue Française, the Wissenschaftlicher Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft fur Anästhesiologie und Intensivmedizen, the Arbeitsgemeinschaft Deutschsprachiger Neuroanästhesisten und Neuro-Intensivmediziner, the Korean Society of Neuroanesthesia, the Japanese Society of Neuroanesthesia and Critical Care, the Neuroanesthesiology Chapter of the Colegio Mexicano de Anesthesiología, the Indian Society of Neuroanesthesiology and Critical Care, and the Thai Society for Neuroanesthesia.