Pickkers P, van der Hoeven J G
UMC St Radboud, afd. Intensive Care, Nijmegen.
Ned Tijdschr Geneeskd. 2013;157(33):A6596.
If an intensive care unit (ICU) is managed by intensivists, the prognosis of critically ill patients improves. Some retrospective analyses of patient databases suggest that critically ill patients admitted to the ICU during off-hours suffer a higher mortality rate compared to patients admitted during office hours. While this suggests that this difference might be related to the presence/absence of experienced intensivists at night, differences in case mix of patients admitted during the day/night may play an important role. Recently, the first prospective randomized controlled trial was published on this issue. Alternating every 7 nights an intensivist was present in the hospital or was available for consultation by telephone. No effect on ICU-length of stay, mortality or any of the secondary end points was found. Despite the compelling face value of nighttime intensivist staffing this practice should not be recommended in the absence of experimental evidence of its effectiveness.
如果重症监护病房（ICU）由重症医学专家管理，危重症患者的预后会得到改善。一些对患者数据库的回顾性分析表明，与在工作时间入住ICU的患者相比，非工作时间入住ICU的危重症患者死亡率更高。虽然这表明这种差异可能与夜间是否有经验丰富的重症医学专家有关，但白天/夜间入住患者的病例组合差异可能起重要作用。最近，关于这个问题发表了第一项前瞻性随机对照试验。每隔7晚交替安排一名重症医学专家在医院值班或提供电话咨询。结果发现，这对ICU住院时间、死亡率或任何次要终点均无影响。尽管夜间配备重症医学专家从表面上看很有吸引力，但在缺乏其有效性的实验证据的情况下，不应推荐这种做法。
