Lassnigg Andrea, Hiesmayr Michael J, Bauer Peter, Haisjackl Markus
Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, General Hospital Vienna, Waehringergürtel 18-20, 1090 Vienna, Austria.
Intensive Care Med. 2002 Oct;28(10):1453-61. doi: 10.1007/s00134-002-1445-9. Epub 2002 Sep 12.
To determine associations between intensive care resource utilisation and centre-, patient- and procedure-related factors.
Prospective multicentre cohort study.
Twenty-one European intensive care units.
Four thousand four hundred adult patients who had undergone cardiac or thoracic aortic surgery in 21 centres.
None (observational study).
Primary outcomes were duration of artificial ventilation and intensive care unit (ICU) length of stay. Exposures were centres and patient- and procedure-related factors. Both outcomes varied fourfold among centres. Median time to extubation varied from 5 to 19 h and ICU length of stay varied from 22 to 91 h. Cox regression analysis was performed to adjust risks of prolonged ventilation and ICU length of stay for patient-, procedure- and centre-related factors. Patient- and procedure-related factors were the main risk factors among individual patients, accounting for nearly two thirds of the risk of prolonged ventilation and ICU length of stay. Centre-related variation accounted for the remaining risk.
In European ICUs resource utilisation is highly variable after cardiac surgery. Up to two thirds more patients could be treated with current ICU resources if the most efficient strategies and structures were applied across all centres.
确定重症监护资源利用与中心、患者及手术相关因素之间的关联。
前瞻性多中心队列研究。
21个欧洲重症监护病房。
在21个中心接受心脏或胸主动脉手术的4400名成年患者。
无（观察性研究）。
主要结局为人工通气时间和重症监护病房（ICU）住院时间。暴露因素为中心以及患者和手术相关因素。两个结局在各中心之间相差四倍。拔管中位时间从5小时到19小时不等，ICU住院时间从22小时到91小时不等。进行Cox回归分析以调整患者、手术和中心相关因素导致通气延长和ICU住院时间延长的风险。患者和手术相关因素是个体患者中的主要危险因素，占通气延长和ICU住院时间延长风险的近三分之二。中心相关差异占其余风险。
在欧洲重症监护病房，心脏手术后资源利用差异很大。如果在所有中心应用最有效的策略和结构，现有ICU资源可多治疗多达三分之二的患者。
