Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Opdam H, Silvester W, Doolan L, Gutteridge G
Department of Intensive Care and Department of Medicine, Austin Hospital, Melbourne, Victoria.
Crit Care Resusc. 2005 Mar;7(1):16-21.
It has been suggested that the availability of a high-dependency unit (HDU), to facilitate graded admission to, and discharge from, an intensive care unit (ICU), might decrease post-operative morbidity. We wished to determine whether the addition of a 4-bed HDU to a tertiary 17-bed ICU facility at a University-affiliated hospital would decrease post-operative morbidity and mortality.
A prospective controlled before-and-after trial was performed with the opening of a 4-bed HDU. Consecutive patients admitted to hospital for major surgery during a 4-month control (pre-HDU) phase and during a 4-month intervention (HDU) phase were studied for the incidence of serious adverse events (SAEs), mortality after major surgery and mean duration of hospital stay.
There were 1319 operations performed in 1125 patients during the pre-HDU period and 1369 operations performed in 1127 patients during the HDU period. During the HDU period there was an excess in unscheduled surgery cases (674 during HDU vs. 531 during the pre-HDU period; p < 0.0001). In the pre-HDU period, there were 414 SAEs in 190 patients compared with 456 SAEs in 209 patients during the HDU period (NS). There were no significant changes in any of the individual SAEs measured except for the incidence of post-operative acute pulmonary edema, which increased from 19 cases to 46 during the HDU period (p = 0.028). This increase was associated with a greater number of patients requiring re-intubation (52 vs. 75 cases; p = 0.044). The introduction of an HDU had no effect on mortality (80 deaths vs. 76; NS) and failed to reduce mean hospital length of stay (21.8 vs. 24 days; NS).
The introduction of a 4-bed HDU in a teaching hospital was associated with a marked increase in unscheduled surgery and failed to reduce the incidence of post-operative SAEs, post-operative mortality, and mean duration of hospital stay.
有人提出，配备高依赖病房（HDU）以促进重症监护病房（ICU）分级收治和转出，可能会降低术后发病率。我们希望确定在一所大学附属医院将一个拥有4张床位的HDU添加到一个有17张床位的三级ICU设施中是否会降低术后发病率和死亡率。
在一个拥有4张床位的HDU启用时进行了一项前瞻性对照前后试验。研究了在4个月的对照（HDU启用前）阶段和4个月的干预（HDU启用后）阶段因大手术入院的连续患者的严重不良事件（SAE）发生率、大手术后死亡率和平均住院时间。
在HDU启用前阶段，1125例患者进行了1319台手术；在HDU启用后阶段，1127例患者进行了1369台手术。在HDU启用后阶段，非计划手术病例有所增加（HDU启用后为674例，HDU启用前为531例；p<0.0001）。在HDU启用前阶段，190例患者发生了414起SAE，而在HDU启用后阶段，209例患者发生了456起SAE（无显著性差异）。除术后急性肺水肿的发生率从19例增加到HDU启用后阶段的46例（p = 0.028）外，所测量的任何个体SAE均无显著变化。这种增加与需要再次插管的患者数量增加有关（分别为52例和75例；p = 0.044）。HDU的引入对死亡率没有影响（80例死亡对76例；无显著性差异），也未能缩短平均住院时间（分别为21.8天和24天；无显著性差异）。
在一家教学医院引入一个拥有4张床位的HDU与非计划手术的显著增加相关，并且未能降低术后SAE的发生率、术后死亡率和平均住院时间。
