Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Coração (InCor), Pulmonary Division, São PauloSP, Brazil.
Clinics (Sao Paulo). 2013;68(8):1103-8. doi: 10.6061/clinics/2013(08)07.
Medical and surgical intensive care unit patients represent two different populations and require different treatment approaches. The aim of this study was to investigate the parameters associated with mortality in medical and surgical intensive care units.
This was a prospective cohort study of adult patients admitted to a medical and surgical intensive care unit teaching hospital over an 11-month period. Factors associated with mortality were explored using logistic regression analysis.
In total, 827 admissions were observed, and 525 patients >18 years old and with a length of stay >24 h were analyzed. Of these patients, 227 were in the medical and 298 were in the surgical intensive care unit. The surgical patients were older (p<0.01) and had shorter lengths of stay (p<0.01). The mortality in the intensive care unit (35.1 vs. 26.2, p = 0.02) and hospital (48.8 vs. 35.5, p<0.01) was higher for medical patients. For patients in the surgical intensive care unit, death was independently associated with the need for mechanical ventilation, prognostic score (SAPS II), community-acquired infection, nosocomial infection, and intensive care unit-acquired infection. For patients in the medical intensive care unit, death was independently associated with the need for mechanical ventilation and prognostic score.
Although the presence of infection is associated with a high mortality in both the medical and surgical intensive care units, the results of this prospective study suggest that infection has a greater impact in patients admitted to the surgical intensive care unit. Measures and trials to prevent and treat sepsis may be most effective in the surgical intensive care unit population.
内科和外科重症监护病房的患者代表两个不同的群体，需要不同的治疗方法。本研究旨在探讨与内科和外科重症监护病房患者死亡率相关的参数。
这是一项针对在 11 个月期间入住内科和外科重症监护病房教学医院的成年患者的前瞻性队列研究。使用逻辑回归分析探讨与死亡率相关的因素。
共观察到 827 例住院患者，对 525 例年龄>18 岁且住院时间>24 小时的患者进行了分析。这些患者中，227 例在内科重症监护病房，298 例在外科重症监护病房。外科患者年龄较大（p<0.01），住院时间较短（p<0.01）。内科重症监护病房（35.1%比 26.2%，p=0.02）和医院（48.8%比 35.5%，p<0.01）的死亡率较高。对于外科重症监护病房的患者，死亡与需要机械通气、预测评分（SAPS II）、社区获得性感染、医院获得性感染和重症监护病房获得性感染独立相关。对于内科重症监护病房的患者，死亡与需要机械通气和预测评分独立相关。
尽管感染的存在与内科和外科重症监护病房的高死亡率相关，但这项前瞻性研究的结果表明，感染对入住外科重症监护病房的患者影响更大。预防和治疗败血症的措施和试验可能在外科重症监护病房人群中最有效。
