Intensive Care Unit, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, Adelaide, SA, 5112, Australia.
Intensive Care Med. 2012 May;38(5):741-51. doi: 10.1007/s00134-012-2519-y. Epub 2012 Apr 5.
This systematic review assessed if outcomes in adult intensive care units (ICUs) are related to hospital and ICU patient volume.
A systematic search strategy was used to identify studies reporting on volume-outcome relationship in adult ICU patients till November 2010. Inclusion of articles was established through a predetermined protocol. Two reviewers assessed studies independently and data extraction was performed using standardized data extraction forms.
A total of 254 articles were screened. Of these 25 were relevant to this study. After further evaluation a total of 13 studies including 596,259 patients across 1,068 ICUs met the inclusion criteria and were reviewed. All were observational cohort studies. Four of the studies included all admissions to ICU, five included mechanically ventilated patients, two reported on patients admitted with sepsis and one study each reported on patients admitted with medical diagnoses and post cardiac arrest patients admitted to ICU, respectively. There was a wide variability in the quantitative definition of volume and classification of hospitals and ICUs on this basis. Methodological heterogeneity amongst the studies precluded a formal meta-analysis. A trend towards favourable outcomes for high volume centres was observed in all studies. Risk-adjusted mortality rates revealed a survival advantage for a specific group of patients in high volume centres in ten studies but no significant difference in outcomes was evident in three studies.
The results indicate that outcomes of certain subsets of ICU patients--especially those on mechanical ventilation, high-risk patients, and patients with severe sepsis--are better in high volume centres within the constraints of risk adjustments.
本系统评价评估成人重症监护病房（ICU）的结局是否与医院和 ICU 患者量相关。
采用系统检索策略，检索截至 2010 年 11 月报道成人 ICU 患者量效关系的研究。通过预定的方案确定文章的纳入。两名评审员独立评估研究，使用标准化的数据提取表格进行数据提取。
共筛选出 254 篇文章，其中 25 篇与本研究相关。进一步评估后，共有 13 项研究（涉及 1068 个 ICU 的 596259 例患者）符合纳入标准并进行了综述。这些研究均为观察性队列研究。其中 4 项研究纳入了所有 ICU 收治患者，5 项研究纳入了机械通气患者，2 项研究报告了脓毒症患者，1 项研究分别报告了内科诊断患者和心脏骤停后收治 ICU 的患者。基于此，对患者量的定量定义和医院及 ICU 的分类存在很大差异。由于研究方法学的异质性，无法进行正式的荟萃分析。所有研究均观察到高容量中心的结局有向好的趋势。10 项研究的风险调整死亡率显示高容量中心的特定患者组具有生存优势，但 3 项研究未显示结局有显著差异。
这些结果表明，某些 ICU 患者亚组（尤其是接受机械通气、高危患者和严重脓毒症患者）的结局在高容量中心更好，但在风险调整的限制下，并非所有 ICU 患者都如此。
