Kastrup M, von Dossow V, Seeling M, Ahlborn R, Tamarkin A, Conroy P, Boemke W, Wernecke K-D, Spies Claudia
Department of Anaesthesiology and Intensive Care, Campus Virchow-Klinikum and Campus Charité Mitte, Charité University Medicine Berlin, Berlin, Germany.
J Int Med Res. 2009 Sep-Oct;37(5):1267-84. doi: 10.1177/147323000903700502.
Expert panel consensus was used to develop evidence-based process indicators that were independent risk factors for the main clinical outcome parameters of length of stay in the intensive care unit (ICU) and mortality. In a retrospective, matched data analysis of patients from five ICUs at a tertiary university hospital, agreed process indicators (sedation monitoring, pain monitoring, mean arterial pressure [MAP] >or= 60 mmHg, tidal volume [TV] <or= 6 ml/kg body weight, peak inspiratory pressure [PIP] <or= 35 cmH(2)O and blood glucose [BG] >or= 80 and <or= 130 mg/dl) were validated using a prospective dataset of 4445 consecutive patients. After matching for age, sex and ICU, 634 patients were analysed. Logistic regression of the 634 patients showed that monitoring analgesia and sedation, MAP >or= 60 mmHg and BG >or= 80 mg/dl were relevant for survival. Linear regression of the 634 patients showed that analgesia monitoring, PIP <or= 35 cmH(2)O and TV <or= 6 ml/kg were associated with reduced length of ICU stay. Linear regression on all 4445 patients showed analgesia, sedation monitoring, MAP >or= 60 mmHg, BG >or= 80 mg/dl and <or= 130 mg/dl, PIP <or= 35 cmH(2)O and TV <or= 6 ml/kg were associated with reduced length of ICU stay, indicating that adherence to evidence-based key process indicators may reduce mortality and length of ICU stay.
专家小组达成共识，制定了基于证据的过程指标，这些指标是重症监护病房（ICU）住院时间和死亡率等主要临床结局参数的独立危险因素。在一所三级大学医院对五个ICU的患者进行回顾性匹配数据分析时，使用4445例连续患者的前瞻性数据集对商定的过程指标（镇静监测、疼痛监测、平均动脉压[MAP]≥60 mmHg、潮气量[TV]≤6 ml/kg体重、吸气峰压[PIP]≤35 cmH₂O和血糖[BG]≥80且≤130 mg/dl）进行了验证。在对年龄、性别和ICU进行匹配后，对634例患者进行了分析。对这634例患者的逻辑回归分析表明，监测镇痛和镇静、MAP≥60 mmHg以及BG≥80 mg/dl与生存相关。对这634例患者的线性回归分析表明，镇痛监测、PIP≤35 cmH₂O以及TV≤6 ml/kg与ICU住院时间缩短相关。对所有4445例患者的线性回归分析表明，镇痛、镇静监测、MAP≥60 mmHg、BG≥80 mg/dl且≤130 mg/dl、PIP≤35 cmH₂O以及TV≤6 ml/kg与ICU住院时间缩短相关，这表明遵循基于证据的关键过程指标可能降低死亡率和ICU住院时间。
