Wahl Wendy L, Arbabi Saman, Zalewski Christy, Wang Stewart C, Hemmila Mark R
Department of Surgery, Trauma Burn Center, University of Michigan Health System, Ann Arbor, MI 481099, USA.
J Burn Care Res. 2010 Jan-Feb;31(1):190-5. doi: 10.1097/BCR.0b013e3181c89f0b.
There are no data on the effects of the Joint Commission on the Accreditation of Healthcare Organizations intensive care unit (ICU) core measures for outcomes in the burn population. The impact of the ICU core measures on patients admitted to burn center was studied. The prospective outcomes measured were hospital length of stay, ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (BSI) rates, and mortality for all burn patients admitted to the ICU. Protocols for the ICU core measures of deep venous thrombosis prophylaxis, stress ulcer prophylaxis, and daily weaning parameters, were in place before the start of the study period in 2005. Head-of-bed up at 30 degrees and glucose control, although variably practiced, were formally instituted in 2005. Enforcement of daily weaning parameters and sedation holidays were also implemented after 2005. The time period before institution of the core measures was 2003 to 2004 (pregroup), which was compared with the study time period of 2006 to 2008 (postgroup). There were no differences in the mean burn size, percent of inhalation injuries, or age between the two time periods. The VAP rate fell from 42/1000 to 13/1000 ventilator days, P = .0001. The BSI rate also declined from 12/1000 to 4/1000 line days, P = .05. Hospital and ICU lengths of stay and ventilator days did not change significantly between the periods. Risk-adjusted mortality for ICU patients improved from 13 to 7% (P = 0.01, odds ratio = 0.5 [0.29-0.85]). Although not specifically designed for the burn population, implementation of the proposed Joint Commission on the Accreditation of Healthcare Organizations ICU core measures for burn patients was associated with improvements in VAP and BSI rates, as well as a lower mortality.
关于医疗保健组织认证联合委员会重症监护病房（ICU）核心措施对烧伤患者治疗结果的影响，目前尚无相关数据。本研究探讨了ICU核心措施对入住烧伤中心患者的影响。所测量的前瞻性结果包括所有入住ICU的烧伤患者的住院时间、呼吸机相关性肺炎（VAP）、导管相关血流感染（BSI）发生率及死亡率。在2005年研究期开始前，已制定了预防深静脉血栓形成、应激性溃疡以及每日撤机参数的ICU核心措施方案。床头抬高30度和血糖控制措施虽在实施上存在差异，但于2005年正式确立。2005年后还实施了每日撤机参数执行情况及镇静假期制度。核心措施实施前的时间段为2003年至2004年（预分组），并与2006年至2008年的研究时间段（后分组）进行比较。两个时间段的平均烧伤面积、吸入性损伤百分比或年龄均无差异。VAP发生率从每1000个呼吸机日42例降至13例，P = .0001。BSI发生率也从每1000个置管日12例降至4例，P = .05。两个时间段之间的住院时间、ICU住院时间及呼吸机使用天数均无显著变化。ICU患者经风险调整后的死亡率从13%降至7%（P = 0.01，比值比 = 0.5 [0.29 - 0.85]）。尽管并非专门针对烧伤患者设计，但医疗保健组织认证联合委员会提议的ICU核心措施在烧伤患者中的实施与VAP和BSI发生率的改善以及较低的死亡率相关。
