Kause Juliane, Smith Gary, Prytherch David, Parr Michael, Flabouris Arthas, Hillman Ken
Clinical Fellow in Intensive Care Medicine, Portsmouth Hospitals NHS Trust, Portsmouth PO6 3LY, UK.
Resuscitation. 2004 Sep;62(3):275-82. doi: 10.1016/j.resuscitation.2004.05.016.
Many patients have physiological deterioration prior to cardiac arrest, death and intensive care unit (ICU) admission, that are detected and documented by medical and nursing staff. Appropriate early response to detected deterioration is likely to benefit patients. In a multi-centre, prospective, observational study over three consecutive days, we studied the incidence of antecedents (serious physiological abnormalities) preceding primary events (defined as in-hospital deaths, cardiac arrests, and unanticipated ICU admissions) in 90 hospitals (69 United Kingdom [UK]; 19 Australia and 2 New Zealand [ANZ]). 68 hospitals reported primary events during the three-day study period (50 United Kingdom, 16 Australia and 2 New Zealand). Data on the availability of ICU/HDU beds and cardiac arrest teams and Medical Emergency Teams were also collected. Of 638 primary events, there were 308 (48.3%) deaths, 141 (22.1%) cardiac arrests, and 189 (29.6%) unplanned ICU admissions. There were differences in the pattern of primary events between the UK and ANZ (P < 0.001). There were proportionally more deaths in the UK (52.3% versus 35.3%) and a higher number of unplanned ICU admissions in ANZ (47.3% versus 24.2%). Sixty percent (383) of primary events had a total of 1032 documented antecedents. The most common antecedents were hypotension and a fall in Glasgow Coma Scale. The proportion of ICU/HDU to general hospital beds was greater in ANZ (0.034 versus 0.016, P < 0.001) and medical emergency teams were more common in ANZ (70.0% versus 27.5%, P = 0.001). The data confirm antecedents are common before death, cardiac arrest, and unanticipated ICU admission. The study also shows differences in patterns of primary events, the provision of ICU/HDU beds and resuscitation teams, between the UK and ANZ. Future research, focusing upon the relationship between service provision and the pattern of primary events, is suggested.
许多患者在心脏骤停、死亡和入住重症监护病房（ICU）之前会出现生理机能恶化，这些情况由医护人员检测并记录下来。对检测到的机能恶化做出适当的早期反应可能会使患者受益。在一项为期三天的多中心、前瞻性观察研究中，我们研究了90家医院（69家位于英国[UK]；19家位于澳大利亚和2家位于新西兰[ANZ]）中主要事件（定义为院内死亡、心脏骤停和意外入住ICU）之前的先兆（严重生理异常）发生率。在为期三天的研究期间，68家医院报告了主要事件（50家位于英国，16家位于澳大利亚，2家位于新西兰）。我们还收集了有关ICU/HDU床位、心脏骤停团队和医疗应急团队可用性的数据。在638起主要事件中，有308起（48.3%）死亡，141起（22.1%）心脏骤停，189起（29.6%）意外入住ICU。英国和ANZ之间的主要事件模式存在差异（P<0.001）。英国的死亡比例相对较高（52.3%对35.3%），而ANZ的意外入住ICU人数较多（47.3%对24.2%）。60%（383起）的主要事件共有1032条记录在案的先兆。最常见的先兆是低血压和格拉斯哥昏迷量表评分下降。ANZ的ICU/HDU床位与综合医院床位的比例更高（0.034对0.016，P<0.001），医疗应急团队在ANZ更常见（70.0%对27.5%，P=0.001）。数据证实，在死亡、心脏骤停和意外入住ICU之前，先兆很常见。该研究还显示了英国和ANZ之间在主要事件模式、ICU/HDU床位供应和复苏团队方面的差异。建议未来开展研究，重点关注服务提供与主要事件模式之间的关系。
