设有和未设中级护理单元的医院中入住重症监护病房的成人患者的医院死亡率：一项欧洲多中心队列研究。
Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study.
作者信息
Capuzzo Maurizia, Volta Carlo, Tassinati Tania, Moreno Rui, Valentin Andreas, Guidet Bertrand, Iapichino Gaetano, Martin Claude, Perneger Thomas, Combescure Christophe, Poncet Antoine, Rhodes Andrew
出版信息
Crit Care. 2014 Oct 9;18(5):551. doi: 10.1186/s13054-014-0551-8.
INTRODUCTION
The aim of the study was to assess whether adults admitted to hospitals with both Intensive Care Units (ICU) and Intermediate Care Units (IMCU) have lower in-hospital mortality than those admitted to ICUs without an IMCU.
METHODS
An observational multinational cohort study performed on patients admitted to participating ICUs during a four-week period. IMCU was defined as any physically and administratively independent unit open 24 hours a day, seven days a week providing a level of care lower than an ICU but higher than a ward. Characteristics of hospitals, ICUs and patients admitted to study ICUs were recorded. The main outcome was all-cause in-hospital mortality until hospital discharge (censored at 90 days).
RESULTS
One hundred and sixty-seven ICUs from 17 European countries enrolled 5,834 patients. Overall, 1,113 (19.1%) patients died in the ICU and 1,397 died in hospital, with a total of 1,397 (23.9%) deaths. The illness severity was higher for patients in ICUs with an IMCU (median Simplified Acute Physiology Score (SAPS) II: 37) than for patients in ICUs without an IMCU (median SAPS II: 29, P <0.001). After adjustment for patient characteristics at admission such as illness severity, and ICU and hospital characteristics, the odds ratio of mortality was 0.63 (95% CI 0.45 to 0.88, P = 0.007) in favour of the presence of IMCU. The protective effect of the IMCU was absent in patients who were admitted for basic observation, for example, after surgery (odds ratio 1.15, 95% CI 0.65 to 2.03, P = 0.630) but was strong in patients admitted to an ICU for other reasons (odds ratio 0.54, 95% CI 0.37 to 0.80, P = 0.002).
CONCLUSIONS
The presence of an IMCU in the hospital is associated with significantly reduced adjusted hospital mortality for adults admitted to the ICU. This effect is relevant for the patients requiring full intensive treatment.
TRIAL REGISTRATION
Clinicaltrials.gov NCT01422070. Registered 19 August 2011.
引言
本研究的目的是评估入住同时设有重症监护病房（ICU）和中级护理病房（IMCU）的医院的成年人，其院内死亡率是否低于入住没有IMCU的ICU的成年人。
方法
一项观察性多国队列研究，对在四周期间入住参与研究的ICU的患者进行。IMCU被定义为任何在物理和管理上独立的单元，每周七天、每天24小时开放，提供低于ICU但高于病房的护理水平。记录医院、ICU以及入住研究ICU的患者的特征。主要结局是直至出院（90天截尾）的全因院内死亡率。
结果
来自17个欧洲国家的167个ICU纳入了5834例患者。总体而言，1113例（19.1%）患者在ICU死亡，1397例在医院死亡，共计1397例（23.9%）死亡。设有IMCU的ICU中的患者病情严重程度高于没有IMCU的ICU中的患者（简化急性生理学评分（SAPS）II中位数：37）（没有IMCU的ICU中的患者SAPS II中位数：29，P<0.001）。在对入院时的患者特征（如病情严重程度）以及ICU和医院特征进行调整后，IMCU存在时的死亡比值比为0.63（95%置信区间0.45至0.88，P = 0.007），有利于IMCU的存在。对于因基本观察入院的患者，例如术后患者，IMCU没有保护作用（比值比1.15，95%置信区间0.65至2.03，P = 0.630），但对于因其他原因入住ICU的患者，IMCU的保护作用很强（比值比0.54，95%置信区间0.37至0.80，P = 0.002）。
结论
医院中存在IMCU与入住ICU的成年人经调整后的院内死亡率显著降低相关。这种效应与需要全面强化治疗的患者相关。
试验注册
Clinicaltrials.gov NCT01422070。2011年8月19日注册。
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