“无墙重症监护室”项目延长至节假日和周末对死亡率的影响。一项前后对照研究。
Effect upon mortality of the extension to holidays and weekends of the "ICU without walls" project. A before-after study.
作者信息
Abella A, Enciso V, Torrejón I, Hermosa C, Mozo T, Molina R, Janeiro D, Díaz M, Homez M, Gordo F, Salinas I
机构信息
Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España.
Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España; Grado de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España.
出版信息
Med Intensiva. 2016 Jun-Jul;40(5):273-9. doi: 10.1016/j.medin.2015.09.001. Epub 2015 Nov 5.
OBJECTIVE
To determine whether extension to holidays and weekends of the protocol for the early proactive detection of severity in hospital ("ICU without walls" project) results in decreased mortality among patients admitted to the ICU during those days.
DESIGN
A quasi-experimental before-after study was carried out.
SETTING
A level 2 hospital with 210 beds and a polyvalent ICU with 8 beds.
PATIENTS OR PARTICIPANTS
The control group involved no "ICU without walls" activity on holidays or weekends and included those patients admitted to the ICU on those days between 1 January 2010 and 30 April 2013. The intervention group in turn extended the "ICU without walls" activity to holidays and weekends, and included those patients admitted on those days between 1 May 2013 and 31 October 2014. Patients arriving from the operating room after scheduled surgery were excluded.
VARIABLES OF INTEREST
An analysis was made of the demographic variables (age, gender), origin (emergency room, hospital ward, operating room), type of patient (medical, surgical), reason for admission, comorbidities and SAPS 3 score as a measure of severity upon admission, stay in the ICU and in hospital, and mortality in the ICU and in hospital.
RESULTS
A total of 389 and 161 patients were included in the control group and intervention group, respectively. There were no differences between the 2 groups except as regards cardiovascular comorbidity (49% in the control group versus 33% in the intervention group; P<.001), severity upon admission (median SAPS 3 score 52 [percentiles 25-75: 42-63) in the control group versus 48 [percentiles 25-75: 40-56] in the intervention group; P=.008) and mortality in the ICU (11% in the control group [95% CI 8-14] versus 3% [95% CI 1-7] in the intervention group; P=.003). In the multivariate analysis, the only 2 factors associated to mortality in the ICU were the SAPS 3 score (OR 1.08; 95% CI 1.06-1.11) and inclusion in the intervention group (OR 0.33; 95% CI 0.12-0.89).
CONCLUSIONS
Extension of the "ICU without walls" activity to holidays and weekends results in a decrease in mortality in the ICU.
目的
确定将医院早期主动检测严重程度的方案（“无墙重症监护室”项目）扩展至节假日和周末是否会降低这些日子入住重症监护室患者的死亡率。
设计
开展了一项前后对比的准实验研究。
地点
一家拥有210张床位的二级医院及一间拥有8张床位的综合重症监护室。
患者或参与者
对照组在节假日或周末不开展“无墙重症监护室”活动，包括2010年1月1日至2013年4月30日期间在这些日子入住重症监护室的患者。干预组则将“无墙重症监护室”活动扩展至节假日和周末，包括2013年5月1日至2014年10月31日期间在这些日子入住的患者。排除计划手术后从手术室送来的患者。
感兴趣的变量
分析了人口统计学变量（年龄、性别）、来源（急诊室、医院病房、手术室）、患者类型（内科、外科）、入院原因、合并症以及作为入院时严重程度衡量指标的简化急性生理学评分（SAPS）3分、在重症监护室和医院的住院时间以及在重症监护室和医院的死亡率。
结果
对照组和干预组分别纳入了389例和161例患者。两组之间除心血管合并症（对照组为49%，干预组为33%；P<0.001）、入院时的严重程度（对照组SAPS 3评分中位数为52[四分位数间距25 - 75：42 - 63]，干预组为48[四分位数间距25 - 75：40 - 56]；P = 0.008）和重症监护室死亡率（对照组为11%[95%置信区间8 - 14]，干预组为3%[95%置信区间1 - 7]；P = 0.003）外，无其他差异。在多变量分析中，与重症监护室死亡率相关的仅有的两个因素是SAPS 3评分（比值比1.08；95%置信区间1.06 - 1.11）和纳入干预组（比值比0.33；95%置信区间0.12 - 0.89）。
结论
将“无墙重症监护室”活动扩展至节假日和周末可降低重症监护室的死亡率。
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