Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
J Am Coll Surg. 2013 Mar;216(3):363-72. doi: 10.1016/j.jamcollsurg.2012.11.008. Epub 2013 Jan 10.
Specialty-trained intensivist involvement in the care of critically ill patients has been associated with improved outcomes; however, the factors contributing to this observation are unknown. We hypothesized that intensivist-led ICU care would result in decreased mortality, length of stay, and rate of deep venous thrombosis/pulmonary embolism along with improved compliance with ICU process measures.
We performed a retrospective review of 847 patients using the October 2008 transition at a regional medical center from an open ICU to a model in which board-certified intensivists assume primary responsibility or co-management of all critically ill patients. Included in the analysis were patients admitted to the ICU during the 3 months immediately before the transition (June to September 2008) and a 3-month period 1 year later (June to September 2009). End points included mortality, length of stay, and deep venous thrombosis/pulmonary embolism rates, as well as several ICU process measures.
Patients in the post-intensivist cohort had a shorter hospital length of stay (7.4 days vs 8.7 days; p = 0.009) and a trend toward decreased mortality (9.3% vs 13.3%; p = 0.086). Patients also received timely initiation of deep venous thrombosis prophylaxis more frequently and tended toward more frequent timely initiation of nutritional support. Patients in the post-intensivist cohort admitted to the ICU with sepsis demonstrated a significant decrease in mortality (11.4% vs 35.0%, p = 0.010), both overall and in patients with APACHE II scores >20.
Intensivist-led ICU care is associated with improved outcomes in patients with sepsis and possibly in all ICU patients. Compliance with selected evidence-based practices improved. Additional study is needed to understand the mechanisms by which the intensivist model improves outcomes.
在危重病患者的治疗中，专科培训的重症监护医生的参与与改善预后相关；然而，导致这种观察结果的因素尚不清楚。我们假设，由重症监护医生领导的 ICU 治疗将降低死亡率、住院时间和深静脉血栓形成/肺栓塞的发生率，并提高 ICU 过程措施的依从性。
我们对一家地区医疗中心的 847 名患者进行了回顾性研究，该中心于 2008 年 10 月从开放式 ICU 过渡到一种模式，即由经过委员会认证的重症监护医生承担所有危重病患者的主要责任或共同管理。分析包括在过渡前 3 个月（2008 年 6 月至 9 月）和 1 年后的 3 个月（2009 年 6 月至 9 月）期间入住 ICU 的患者。终点包括死亡率、住院时间和深静脉血栓形成/肺栓塞的发生率，以及几项 ICU 过程措施。
在后重症监护医生组中，患者的住院时间更短（7.4 天比 8.7 天；p = 0.009），死亡率有降低的趋势（9.3%比 13.3%；p = 0.086）。患者也更频繁地及时开始深静脉血栓预防，并且更倾向于更频繁地及时开始营养支持。在后重症监护医生组中，入住 ICU 的脓毒症患者的死亡率显著降低（11.4%比 35.0%，p = 0.010），无论是总体死亡率还是 APACHE II 评分>20 的患者。
由重症监护医生领导的 ICU 治疗与脓毒症患者的改善预后相关，可能与所有 ICU 患者的预后相关。对选定的基于证据的实践的依从性提高。需要进一步研究以了解重症监护医生模式改善预后的机制。
