Publikationsserver der Universitätsbibliothek Marburg

Titel:Braucht der erfahrene Arzt ein Pulsoximeter? Eine Beobachtungsstudie zur Reliabilität klinischer Hypoxämiekontrolle
Autor:Brieskorn, Melanie
Weitere Beteiligte: Eberhart, Leopold (Prof. Dr.)
Veröffentlicht:2012
URI:https://archiv.ub.uni-marburg.de/diss/z2012/0152
URN: urn:nbn:de:hebis:04-z2012-01529
DOI: https://doi.org/10.17192/z2012.0152
DDC: Medizin, Gesundheit
Titel(trans.):Does a well experienced doctor need the pulse oximetry? An observational study of the reliability of clinical control of hypoxaemia
Publikationsdatum:2012-02-16
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
Hypoxämie, Berufserfahrung, Pulsoxymetrie, hypoxaemia, pulse oximetry

Zusammenfassung:
Zusammenfassung Einleitung: Die Hypoxämie ist eine der häufigsten postoperativen Komplikationen. Deshalb ist es von großer Bedeutung, eine Hypoxämie im postoperativen Verlauf frühzeitig und sicher zu erkennen, um die Patienten nicht zu gefährden. Mit der Pulsoximetrie existiert eine etablierte Methode, die eine Hypoxämie mit hoher Sensitivität detektiert. In den letzten Jahren wird jedoch zunehmend das Konzept der Fast-Track-Anästhesie angewandtt, bei dem die Patienten postoperativ ohne apparatives Monitoring und unter Umgehung des Aufwachraums direkt aus dem Operationssaal auf die Station verlegt werden. Deshalb soll in dieser Studie untersucht werden, wie verlässlich die Detektion einer Hypoxämie anhand klinischer Zeichen ist, ob die Qualität der Hypoxämieevaluation mit steigender Berufserfahrung des Personals steigt und ob sich das Erkennen von Hypoxämien erlernen lässt. Material und Methoden: Die Studie umfasst 1145 Patienten, die zwischen Mai 2009 und Januar 2010 an der Universitätsklinik Marburg operiert worden sind. In die Studie eingeschlossen wurden alle Patienten, die eine Vollnarkose erhielten und nach der Operation im Aufwachraum überwacht wurden. Ausgeschlossen wurden Patienten, die während des Transportes vom Operationssaal in den Aufwachraum Sauerstoff erhielten, die direkt auf eine Intensivstation verlegt wurden und solche, die lediglich eine Regionalanästhesie erhielten. Die Sauerstoffsättigung der Patienten wurde an der Schleuse zwischen Operationstrakt und Aufwachraum durch den begleitenden Anästhesisten, eine Person vom Pflegepersonal sowie einen Doktoranden anhand der klinischen Zeichen Zyanose und Tachypnoe evaluiert und gleichzeitig durch ein Pulsoximeter gemessen. Die vom Pulsoximeter gemessenen und die vom Personal angegebenen Werte wurden verglichen und mittels Bland-Altman-Plots dargestellt. Die Anästhesisten wurden entsprechend ihrer Qualifikation in drei Gruppen (Oberarzt, Facharzt, Assistenzarzt) eingeteilt, um die Qualitäten ihrer Evaluationen der Berufserfahrung gegenüberzustellen. Außerdem wurden die Qualitäten der Evaluationen über den Zeitraum der Studie dahingehend untersucht, ob sich eine Lernkurve ableiten lässt. Ergebnisse: Die Inzidenz der Hypoxämie betrug 13,8%. Die Anästhesisten erkannten anhand klinischer Zeichen eine vorliegende Hypoxämie bei den Patienten mit einer Sensitivität von 8,1%, das Pflegepersonal und die Doktoranden mit einer Sensitivität von 2,7%. Es zeigt sich außerdem, dass die Qualität der Hypoxämieevaluation mit zunehmender Berufserfahrung nicht steigt (p=0,9892). Eine Lernkurve über den Zeitraum der Studie lässt sich ebenfalls nicht nachweisen, wenn man die Qualitäten der klinischen Hypoxämieevaluation der Doktoranden zu Beginn der Studie mit denen am Ende vergleicht. Diskussion: Zyanose und Tachypnoe sind unzuverlässige klinische Zeichen, um eine Hypoxämie klinisch zu erkennen. Die Sensitivität dieser Methode zum Erkennen einer Hypoxämie ist niedrig (8,1% bzw. 2,7%), auch wenn das Personal viele Jahre Berufserfahrung vorzuweisen hat. Mit der Pulsoximetrie existiert jedoch ein Messverfahren, welches mit hoher Sensitivität eine Hypoxämie beim Patienten detektiert. Deshalb sollten Patienten auch bei Anwendung des Fast-Track-Konzeptes mittels eines Pulsoximeters im postoperativen Verlauf überwacht werden, um die Patientensicherheit zu gewährleisten.

Summary:
I. Summary Introduction: Hypoxemia is one of the most frequently observed complications after anesthesia. Therefore it is important to detect hypoxemia reliably to prevent serious damage to the patients’ health. Pulse oximetry provides an established method for detecting hypoxemia with a high sensitivity. Recently, fast-track anesthesia has become more and more popular in anesthesia. Fast-track means that the patients are transported directly from the operating room to the ward, without any monitoring. In view of the fact that hypoxemia after anesthesia is common, it is important to examine how reliable the clinical detection of hypoxemia is and if the professional experience of the medical staff affects the quality of the detection. Material and methods: In our study we examined 1145 patients who underwent an operation at the university hospital of Marburg between May 2009 and January 2010. Inclusion criteria were general anesthesia with intubation tube or laryngeal mask airway and the postoperative stay in the PACU (post-anesthesia care unit). Patients who were given oxygen during transport from the operating room to the PACU, patients who were transferred directly to the intensive care unit and those who were just given a regional anesthesia were excluded from the study. The patients’ oxygen saturation was judged at the entrance to the PACU by the attending anesthetist, one person of the nursing staff and one of the doctoral students based on the clinical signs cyanosis and tachypnoea. Simultaneously, the oxygen saturation was measured by pulse oximeter. The measured data of the pulse oximetry and the staffs’ estimated data based solely on clinical signs were compared in Bland-Altman-Plots. The anesthetists were classified into three groups (resident, fellow, attending) for comparing the quality of their estimated data with their professional experience. Furthermore, we analysed the quality of the doctoral students’ estimated data during the period of the study. We defined hypoxemia as follows: <90% mild hypoxemia, <85% severe hypoxemia. Results: The incidence of hypoxemia in our study was 13,8%. The anesthetists detected hypoxemia based on clinical signs with a sensitivity of 8,1%, the nursing staff and the doctoral students with a sensitivity of 2,7%. Our study shows that there is no correlation between the quality of data and the professional experience of the anesthetists (p=0,9892). Additionally, there is no statistically relevant learning curve for the performance of the doctoral students during the period of investigation. Discussion: Cyanosis and tachypnoea are unreliable clinical signs for detecting hypoxemia. The sensitivity of this method for detecting hypoxemia is very low, even if the staff is experienced (8,1% and 2,7% respectively). For that reason, patients should be monitored by pulse oximetry, if fast-track anesthesia is applied.

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