Department of Anesthesia, Vanderbilt University, Nashville, TN, USA.
Crit Care Med. 2013 Aug;41(8):1844-52. doi: 10.1097/CCM.0b013e31828a3e24.
To define the prevalence, indications, and temporal trends in obstetric-related ICU admissions.
Descriptive analysis of utilization patterns.
All hospitals within the state of Maryland.
All antepartum, delivery, and postpartum patients who were hospitalized between 1999 and 2008.
None.
We identified 2,927 ICU admissions from 765,598 admissions for antepartum, delivery, or postpartum conditions using appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes. The overall rate of ICU utilization was 419.1 per 100,000 deliveries, with rates of 162.5, 202.6, and 54.0 per 100,000 deliveries for the antepartum, delivery, and postpartum periods, respectively. The leading diagnoses associated with ICU admission were pregnancy-related hypertensive disease (present in 29.9% of admissions), hemorrhage (18.8%), cardiomyopathy or other cardiac disease (18.3%), genitourinary infection (11.5%), complications from ectopic pregnancies and abortions (10.3%), nongenitourinary infection (10.1%), sepsis (7.1%), cerebrovascular disease (5.8%), and pulmonary embolism (3.7%). We assessed for changes in the most common diagnoses in the ICU population over time and found rising rates of sepsis (10.1 per 100,000 deliveries to 16.6 per 100,000 deliveries, p = 0.003) and trauma (9.2 per 100,000 deliveries to 13.6 per 100,000 deliveries, p = 0.026) with decreasing rates of anesthetic complications (11.3 per 100,000 to 4.7 per 100,000, p = 0.006). The overall frequency of obstetric-related ICU admission and the rates for other indications remained relatively stable.
Between 1999 and 2008, 419.1 per 100,000 deliveries in Maryland were complicated by ICU admission. Hospitals providing obstetric services should plan for appropriate critical care management and/or transfer of women with severe morbidities during pregnancy.
定义产科相关 ICU 入院的患病率、适应证和时间趋势。
利用模式进行描述性分析。
马里兰州所有医院。
1999 年至 2008 年间住院的所有产前、分娩和产后患者。
无。
我们使用适当的国际疾病分类第 9 版临床修订版代码，从 765598 例产前、分娩或产后疾病住院患者中确定了 2927 例 ICU 入院患者。ICU 使用率的总体率为每 100000 例分娩 419.1 例，分别为产前、分娩和产后时期的 162.5、202.6 和 54.0 例。与 ICU 入院相关的主要诊断为妊娠相关高血压疾病（占入院人数的 29.9%）、出血（18.8%）、心肌病或其他心脏疾病（18.3%）、泌尿生殖系统感染（11.5%）、异位妊娠和流产并发症（10.3%）、非泌尿生殖系统感染（10.1%）、败血症（7.1%）、脑血管疾病（5.8%）和肺栓塞（3.7%）。我们评估了 ICU 人群中最常见诊断随时间的变化，发现败血症（每 100000 例分娩 10.1 例至每 100000 例分娩 16.6 例，p=0.003）和创伤（每 100000 例分娩 9.2 例至每 100000 例分娩 13.6 例，p=0.026）的发生率上升，而麻醉并发症的发生率（每 100000 例分娩 11.3 例降至每 100000 例分娩 4.7 例，p=0.006）下降。产科相关 ICU 入院的总体频率和其他适应证的发生率相对稳定。
1999 年至 2008 年间，马里兰州每 100000 例分娩中有 419.1 例因 ICU 入院而复杂化。提供产科服务的医院应计划在怀孕期间对严重合并症的妇女进行适当的重症监护管理和/或转移。
