Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Crit Care Med. 2011 Jan;39(1):84-8. doi: 10.1097/CCM.0b013e3181fd6aef.
Following two randomized controlled trials that demonstrated reduced mortality and better neurological outcome in cardiac arrest patients, mild therapeutic hypothermia was implemented in many intensive care units. Up to now, no large observational studies have confirmed the beneficial effects of mild therapeutic hypothermia.
Internet-based survey combined with a retrospective, observational study.
All patients admitted to an intensive care unit in The Netherlands after cardiac arrest from January 1, 1999 until January 1, 2009.
Dutch National Intensive Care Evaluation database.
The moment of implementation of mild therapeutic hypothermia for each hospital participating in the Dutch National Intensive Care Evaluation database was determined with an Internet survey. To compare mortality before and after implementation of mild therapeutic hypothermia, the odds ratio adjusted for Simplified Acute Physiology Score II score, age, gender, propensity score, and in- or out-of-hospital cardiac arrest was calculated. Patients were excluded if 1) they were admitted to an intensive care unit that did not respond to the survey, 2) they were admitted within 3 months after implementation of mild therapeutic hypothermia, 3) they had a Glasgow Coma Scale score of >8, or 4) they did not satisfy the Simplified Acute Physiology Score II inclusion criteria.
None.
A total of 13,962 patients were admitted to an intensive care unit following cardiac arrest. In total 8,645 patients were excluded, 5,544 because of a Glasgow Coma Scale score of >8. Of the resultant 5,317 patients, 1,547 patients were treated before and 3,770 patients after implementation of mild therapeutic hypothermia. Patients admitted after implementation of mild therapeutic hypothermia had lower minimal and maximal temperatures (p < .0001) during the first 24 hrs on the intensive care unit compared to patients admitted before implementation of mild therapeutic hypothermia. The adjusted odds ratio of the hospital mortality of patients treated after implementation of mild therapeutic hypothermia was 0.80 (95% confidence interval of 0.65-0.98, p = .029).
The results of this retrospective, observational survey suggest that implementation of mild therapeutic hypothermia in Dutch intensive care units is associated with a 20% relative reduction of hospital mortality in cardiac arrest patients.
在两项随机对照试验表明心脏骤停患者的死亡率降低和神经功能预后改善后，轻度治疗性低温已在许多重症监护病房中实施。到目前为止，还没有大型观察性研究证实轻度治疗性低温的有益效果。
基于互联网的调查与回顾性观察性研究相结合。
1999 年 1 月 1 日至 2009 年 1 月 1 日期间，荷兰重症监护病房中因心脏骤停而入院的所有患者。
荷兰国家重症监护评估数据库。
通过互联网调查确定每个参与荷兰国家重症监护评估数据库的医院实施轻度治疗性低温的时间。为了比较实施轻度治疗性低温前后的死亡率，计算了调整简化急性生理学评分 II 评分、年龄、性别、倾向评分和院内或院外心脏骤停的优势比。如果患者 1）被收入未回复调查的重症监护病房，2）在实施轻度治疗性低温后 3 个月内入院，3）格拉斯哥昏迷评分>8，或 4）不符合简化急性生理学评分 II 纳入标准，则排除这些患者。
无。
共有 13962 例患者因心脏骤停入住重症监护病房。共有 8645 例患者被排除，其中 5544 例患者的格拉斯哥昏迷评分>8。在剩余的 5317 例患者中，1547 例患者在实施轻度治疗性低温前接受治疗，3770 例患者在实施轻度治疗性低温后接受治疗。与实施轻度治疗性低温前入院的患者相比，在重症监护病房的前 24 小时内，实施轻度治疗性低温后入院的患者的最低和最高体温较低（p<.0001）。实施轻度治疗性低温后接受治疗的患者的医院死亡率调整后的优势比为 0.80（95%置信区间为 0.65-0.98，p=0.029）。
这项回顾性观察性调查的结果表明，在荷兰重症监护病房中实施轻度治疗性低温与心脏骤停患者的医院死亡率相对降低 20%相关。
