Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.
Resuscitation. 2016 Mar;100:1-5. doi: 10.1016/j.resuscitation.2015.11.029. Epub 2015 Dec 31.
Diurnal variation in the performance of rapid response systems has not been fully elucidated. Afferent limb failure (ALF) is a significant problem and is an important measure of performance of rapid response systems.
To determine the diurnal variation in the detection and response to acute patient deterioration as measured by ALF, completeness of patient observations (Respiratory rate (RR); Pulse rate (PR) and Systolic blood pressure (SBP), and to explore the diurnal variation in the consequences of ALF in unanticipated admissions to the Intensive care unit (ICU) from the ward.
DESIGN, SETTING AND PARTICIPANTS: Point Prevalence study conducted on two days in 2012 in 41 ICUs in Australia and New Zealand, examining emergency (unanticipated) admissions to the ICU from the ward.
51 patients from the ward were admitted as an emergency to the ICU following a rapid response team call, of whom 48 patients had complete datasets and were enrolled; 32 (67%) were men. The prevalence of ALF was 37.5% (18/48). Median age was 62.5 (IQR 51.5-74.0), Median APACHE II score was 21.0 (IQR 17-26). There was no diurnal variation in the prevalence of ALF (day 28% versus night 28%; p=0.92), patient observations documented over time (p=0.78 for RR, p=0.95 for PR and p=0.74 for SBP) or 28-day mortality (p=0.24). There was a significant diurnal variation between the least recorded observation (SBP) and the most recorded observation (PR) (p<0.01). ALF was more likely (day and night) if a complete set of observations had been taken (p<0.01).
The prevalence of ALF amongst patients admitted to the ICU from the ward is high. SBP is the least recorded patient observation. This study was unable to identify a diurnal variation in the prevalence of ALF, its consequences (i.e. mortality) and the completeness of patient observations. Observational studies with a larger sample are required to explore this important problem.
快速反应系统的性能存在昼夜变化，但尚未完全阐明。传入支衰竭（ALF）是一个重大问题，也是衡量快速反应系统性能的重要指标。
通过 ALF 来确定急性患者病情恶化的检测和反应的昼夜变化、患者观察的完整性（呼吸频率（RR）；脉搏率（PR）和收缩压（SBP）），并探讨 ALF 对从病房转入重症监护病房（ICU）的意外入院患者的后果的昼夜变化。
设计、地点和参与者：2012 年在澳大利亚和新西兰的 41 个 ICU 进行了两天的点现患率研究，检查了从病房紧急（意外）转入 ICU 的患者。
有 51 名来自病房的患者在接到快速反应小组的电话后被紧急转入 ICU，其中 48 名患者有完整的数据集并被纳入；32 名（67%）为男性。ALF 的患病率为 37.5%（18/48）。中位年龄为 62.5（IQR 51.5-74.0），中位急性生理与慢性健康评分（APACHE II）为 21.0（IQR 17-26）。ALF 的患病率无昼夜变化（第 2 天 28%与夜间 28%；p=0.92），随着时间推移记录的患者观察结果（RR 的 p=0.78、PR 的 p=0.95 和 SBP 的 p=0.74）或 28 天死亡率（p=0.24）无差异。记录最少的观察值（SBP）与记录最多的观察值（PR）之间存在显著的昼夜差异（p<0.01）。如果已完成完整的观察，则更有可能发生 ALF（白天和夜间）（p<0.01）。
从病房转入 ICU 的患者中 ALF 的患病率较高。SBP 是记录最少的患者观察值。本研究未能确定 ALF 的患病率、其后果（即死亡率）和患者观察的完整性是否存在昼夜变化。需要进行样本量更大的观察性研究来探索这一重要问题。
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