Respiratory Department, FSM, Lumezzane, Italy.
Intensive Care Med. 2010 Jan;36(1):137-42. doi: 10.1007/s00134-009-1658-2. Epub 2009 Sep 26.
Respiratory intensive care units (RICU) dedicated to weaning could be suitable facilities for clinical management of "post-ICU" patients.
We retrospectively analyzed the time course of patients' characteristics, clinical outcomes and medical staff utilization in five Italian RICUs by comparing three periods of 5 consecutive years (from 1991 to 2005).
A total of 3,106 patients (age 76 +/- 4 years; 72% males) were analyzed. The number of co-morbidities per patient (from 1.8 to 3.0, p = 0.05) and the previous intensive care unit (ICU) stay (from 25 to 32 days, p = 0.002) increased over time. The doctor-to-patient ratio significantly decreased over time (from 1:3 to 1:5, p < 0.01), whereas the physiotherapist-to-patient ratio mildly increased (from 1:6 to 1:4.5, p < 0.05). The overall weaning success rate decreased (from 87 to 66%, p < 0.001), and the discharge destination changed (p < 0.001) over time; fewer patients were discharged to home (from 22 to 10%), and more patients to nursing home (from 3 to 6%), acute hospitals (from 6 to 10%) and rehabilitative units (from 70 to 75%). The mortality rate increased over time (from 9 to 15%). Significant correlations between the doctor-to-patient ratio and the rates of weaning success (r = 0.679, p = 0.005), home discharge (r = 0.722, p = 0.002) and the RICU length of stay (LOS) (r = -0.683, p = 0.005) were observed.
The clinical outcomes of our units worsened over 15 years, likely as consequence of admitting more severely ill patients. The potential further negative influence of reduced medical staff availability on weaning success, home discharge and LOS warrants future prospective investigations.
专门用于脱机的呼吸重症监护病房（RICU）可能是“ICU 后”患者临床管理的合适场所。
我们通过比较五个意大利 RICU 连续 5 年的三个时期（1991 年至 2005 年），回顾性分析了患者特征、临床结局和医务人员利用情况的时间过程。
共分析了 3106 例患者（年龄 76±4 岁；72%为男性）。每位患者的合并症数量（从 1.8 到 3.0，p=0.05）和之前的 ICU 住院时间（从 25 天到 32 天，p=0.002）随时间增加。医生与患者的比例随时间显著下降（从 1:3 到 1:5，p<0.01），而物理治疗师与患者的比例略有增加（从 1:6 到 1:4.5，p<0.05）。总体脱机成功率下降（从 87%降至 66%，p<0.001），出院去向随时间改变（p<0.001）；更少的患者出院回家（从 22%降至 10%），更多的患者出院到疗养院（从 3%增至 6%）、急性医院（从 6%增至 10%）和康复病房（从 70%增至 75%）。死亡率随时间增加（从 9%增至 15%）。医生与患者的比例与脱机成功率（r=0.679，p=0.005）、家庭出院率（r=0.722，p=0.002）和 RICU 住院时间（LOS）（r=-0.683，p=0.005）呈显著相关。
我们单位的临床结局在 15 年内恶化，可能是由于收治了更多病重的患者。医务人员减少对脱机成功率、家庭出院率和 LOS 的潜在负面影响需要未来前瞻性研究。
