Impacts of quality improvement in hemodynamic monitoring on fluid overload and prognosis in neonates with septic shock
10.3760/cma.j.issn.2096-2932.2023.12.002
- VernacularTitle:血流动力学监测质量改进对脓毒性休克新生儿液体超负荷及预后的影响
- Author:
Dongju MA
1
;
Junjuan ZHONG
;
Yingyi LIN
;
Jing ZHANG
;
Jing MO
;
Chun SHUAI
;
Yue WANG
;
Xiuzhen YE
Author Information
1. 国家临床重点专科建设项目单位/广东省妇幼保健院新生儿科，广东省新生儿重症医学专业质量控制中心，广州 510000
- Keywords:
Fluid overload;
Quality improvement;
Hemodynamic monitoring;
Septic shock
- From:Chinese Journal of Neonatology
2023;38(12):710-714
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the effect of quality improvement of hemodynamic monitoring on fluid overload (FO) and outcome in newborns with septic shock.Methods:Non-invasive cardiac output monitoring and functional cardiac ultrasound quality improvement program was started during January 2020 in our hospital. Neonates with septic shock admitted before and after the program were retrospectively analyzed. From January 2018 to December 2019 was pre-improvement period when fluid resuscitation was routinely performed and vasoactive drugs was selected empirically. From January 2020 to December 2021 was post-improvement period when fluid resuscitation and/or use and adjustment of vasoactive drugs were guided by hemodynamic parameters. The 24 h, 48 h, 72 h FO, duration of invasive respiratory support, vasoactive-inotropic score, septic shock score, incidences of complications and all-cause mortality were compared between the two groups.Results:A total of 284 eligible cases were enrolled, including 136 cases in pre-improvement group and 148 cases in post-improvement group. Post-improvement group had significantly lower gestational age (GA), birth weight (BW) and body weight at disease onset than pre-improvement group ( P<0.05). Incidences of 48 h and 72 h FO, fluid resuscitation volume within 72 h, pulmonary hemorrhage and periventricular leukomalacia (PVL) were significantly lower in the post-improvement group ( P<0.05). No significant differences existed in 24 h FO, other complications and all-cause mortality between the two groups ( P>0.05). No significant differences existed in GA and BW for neonates with pulmonary hemorrhage and PVL between the two groups ( P>0.05). Conclusions:Quality improvement of hemodynamic monitoring can effectively improve FO and reduce the incidences of pulmonary hemorrhage and PVL.
