远程重症监护患者远程监测的远程医疗与死亡率、并发症和住院时间的关系。

Association of telemedicine for remote monitoring of intensive care patients with mortality, complications, and length of stay.

机构信息

Department of Internal Medicine, School of Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.

出版信息

JAMA. 2009 Dec 23;302(24):2671-8. doi: 10.1001/jama.2009.1902.

DOI:10.1001/jama.2009.1902

PMID:20040555

Abstract

CONTEXT

Telemedicine technology, which can enable intensivists to simultaneously monitor several intensive care units (ICUs) from an off-site location, is increasingly common, but there is little evidence to support its use.

OBJECTIVE

To assess the association of remote monitoring of ICU patients (ICU telemedicine [tele-ICU]) with mortality, complications, and length of stay (LOS).

DESIGN, SETTING, AND PATIENTS: Observational study conducted in 6 ICUs of 5 hospitals in a large US health care system to assess the use of tele-ICU. The study included 2034 patients in the preintervention period (January 2003 to August 2005) and 2108 patients in the postintervention period (July 2004 to July 2006).

MAIN OUTCOME MEASURES

Hospital and ICU mortality, complications, and hospital and ICU survivors' LOS, with outcomes adjusted for severity of illness.

RESULTS

Local physicians delegated full treatment authority to the tele-ICU for 655 patients (31.1%) and authority to intervene only in life-threatening events for the remainder. Observed hospital mortality rates were 12.0% (95% confidence interval [CI], 10.6% to 13.5%) in the preintervention period and 9.9% (95% CI, 8.6% to 11.2%) in the postintervention period (preintervention to postintervention decrease, 2.1%; 95% CI, 0.2% to 4.1%; P = .03); observed ICU mortality rates were 9.2% (95% CI, 8.0% to 10.5%) in the preintervention period and 7.8% (95% CI, 6.7% to 9.0%) in the postintervention period (preintervention to postintervention decrease, 1.4%; 95% CI, -0.3% to 3.2%; P = .12). After adjustment for severity of illness, there were no significant differences associated with the telemedicine intervention for hospital mortality (relative risk, 0.85; 95% CI, 0.71 to 1.03) or for ICU mortality (relative risk, 0.88; 95% CI, 0.71 to 1.08). There was a significant interaction between the tele-ICU intervention and severity of illness (P < .001), in which tele-ICU was associated with improved survival in sicker patients but with no improvement or worse outcomes in less sick patients. There were no significant differences between the preintervention and postintervention periods for hospital or ICU LOS.

CONCLUSION

Remote monitoring of ICU patients was not associated with an overall improvement in mortality or LOS.

摘要

背景

远程医疗技术可以使重症监护医生能够从远程位置同时监测多个重症监护病房（ICU），这种技术已经越来越普遍，但目前几乎没有证据支持其使用。

目的

评估 ICU 患者远程监测（ICU 远程医疗[远程 ICU]）与死亡率、并发症和住院时间（LOS）的关系。

设计、地点和患者：在美国一个大型医疗保健系统的 5 家医院的 6 个 ICU 中进行的观察性研究，旨在评估远程 ICU 的使用情况。该研究包括干预前（2003 年 1 月至 2005 年 8 月）的 2034 名患者和干预后（2004 年 7 月至 2006 年 7 月）的 2108 名患者。

主要结局测量

医院和 ICU 死亡率、并发症以及医院和 ICU 幸存者的 LOS，使用疾病严重程度对结果进行调整。

结果

当地医生将全部治疗权委托给远程 ICU 的患者有 655 名（31.1%），仅授权在危及生命的情况下进行干预的患者有 1353 名。干预前的医院死亡率为 12.0%（95%置信区间[CI]，10.6%至 13.5%），干预后的死亡率为 9.9%（95% CI，8.6%至 11.2%）（干预前至干预后的下降为 2.1%；95% CI，0.2%至 4.1%；P =.03）；干预前 ICU 死亡率为 9.2%（95% CI，8.0%至 10.5%），干预后为 7.8%（95% CI，6.7%至 9.0%）（干预前至干预后的下降为 1.4%；95% CI，-0.3%至 3.2%；P =.12）。在调整疾病严重程度后，远程医疗干预与医院死亡率（相对风险，0.85；95% CI，0.71 至 1.03）或 ICU 死亡率（相对风险，0.88；95% CI，0.71 至 1.08）之间均无显著关联。远程 ICU 干预与疾病严重程度之间存在显著的交互作用（P <.001），在这种交互作用中，远程 ICU 与病情较重患者的存活率提高相关，但在病情较轻的患者中则没有改善或预后更差。干预前和干预后，医院或 ICU LOS 之间无显著差异。