Department of Intensive Care Medicine and Critical Care Medicine Research Group, Tampere University Hospital, Tampere, Finland.
Acta Anaesthesiol Scand. 2013 Jan;57(1):56-62. doi: 10.1111/aas.12013. Epub 2012 Nov 21.
Patients discharged from the intensive care unit (ICU) are at increased risk for serious adverse events (SAEs). Recording vital functions and comprehending the consequences of altered vitals on general wards may be suboptimal. This potentially endangers recovery after successful intensive care. We aimed to determine the prevalence of vital dysfunctions after ICU discharge and their effect on patient outcome.
A prospective observational study. Adult patients discharged from a tertiary referral hospital ICU to general wards without treatment limitations were visited 24 h afterwards; their vitals were measured and reported to ward staff. Attending ward nurse responsible for patient was interviewed.
The cohort consisted of 184 patients who had survived the first 24 h on the ward without complications (age: 57 ± 16 years; male: 68%). The prevalence of objectively measured vital dysfunctions was 15%, and the attending nurse had been unusually concerned about the patient in 19% of cases. Of the 184 patients, 9.8% subsequently suffered an SAE. In a multivariate logistic regression model, only vital dysfunctions (odds ratio 3.79; 95% confidence interval 1.18-12.2) and nurse concern (3.63; 1.17-11.3) were independently associated with an increased incidence of SAE. Medical emergency team (MET) assistance was never considered necessary by ward staff. Sensitivity of observed altered vitals on SAEs was 50% and specificity 89%. Sensitivity of nurse concern was 26%, specificity 84%.
Simple vital function measurement and attending ward nurse's subjective assessment facilitate early detection of post-ICU patients at risk. The threshold in seeking assistance through MET remains high.
从重症监护病房（ICU）出院的患者发生严重不良事件（SAE）的风险增加。在普通病房记录生命体征并理解生命体征改变的后果可能并不理想。这可能会危及重症监护后的恢复。我们旨在确定 ICU 出院后生命功能障碍的发生率及其对患者预后的影响。
前瞻性观察研究。从三级转诊医院 ICU 出院到普通病房且无治疗限制的成年患者在出院后 24 小时接受访视；测量他们的生命体征并报告给病房工作人员。采访负责患者的值班护士。
该队列包括 184 名在没有并发症的情况下在病房度过前 24 小时的存活患者（年龄：57±16 岁；男性：68%）。客观测量的生命功能障碍的发生率为 15%，19%的情况下值班护士对患者感到异常担忧。在 184 名患者中，9.8%随后发生 SAE。在多变量逻辑回归模型中，只有生命功能障碍（优势比 3.79；95%置信区间 1.18-12.2）和护士的关注（3.63；1.17-11.3）与 SAE 的发生率增加独立相关。病房工作人员从未认为需要医疗急救小组（MET）的帮助。观察到的生命体征改变对 SAE 的敏感性为 50%，特异性为 89%。护士关注的敏感性为 26%，特异性为 84%。
简单的生命功能测量和值班护士的主观评估有助于早期发现 ICU 后有风险的患者。通过 MET 寻求帮助的阈值仍然很高。
