Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
J Crit Care. 2017 Oct;41:209-215. doi: 10.1016/j.jcrc.2017.05.025. Epub 2017 May 24.
Little is known about the association between advanced practice nursing and mortality. The aim of this study was to evaluate whether the presence of advanced practice nurses (APN), that is, certified nurse (CN) and certified nurse specialist (CNS) in intensive care, is associated with 30-day mortality for mechanically ventilated critically ill patients.
Using a Japanese national in-patient database, we identified 45,620 patients who were admitted to an intensive care unit (ICU) and received mechanical ventilation within 2 days of hospital admission between 1 April 2014 and 31 March 2015. We assessed the association between the number of CN/CNSs per 10 adult ICU beds and 30-day mortality.
We examined 8955 patients in 134 hospitals without CN/CNSs and 36,665 in 284 hospitals with CN/CNSs. Overall, the number of CN/CNSs per 10 adult ICU beds ranged from 0 to 7.5. In the multivariable analysis, the number of CN/CNSs per 10 adult ICU beds was significantly associated with a reduction in 30-day mortality (adjusted odds ratio 0.97; 95% confidence interval, 0.94-1.00; P=0.023).
Our findings show that APNs may play an important role in improving patient outcome in the adult ICU.
关于高级实践护士与死亡率之间的关联，人们知之甚少。本研究旨在评估重症监护室（ICU）中是否存在高级实践护士（APN），即注册护士（CN）和认证护士专家（CNS），与机械通气的危重病患者 30 天死亡率是否相关。
我们使用日本国家住院患者数据库，确定了 2014 年 4 月 1 日至 2015 年 3 月 31 日期间，在住院后 2 天内入住 ICU 并接受机械通气的 45620 名患者。我们评估了每 10 张成人 ICU 床位的 CN/CNS 数量与 30 天死亡率之间的关联。
我们在 134 家没有 CN/CNS 的医院中检查了 8955 名患者，在 284 家有 CN/CNS 的医院中检查了 36665 名患者。总体而言，每 10 张成人 ICU 床位的 CN/CNS 数量从 0 到 7.5 不等。在多变量分析中，每 10 张成人 ICU 床位的 CN/CNS 数量与 30 天死亡率降低显著相关（调整后的优势比 0.97；95%置信区间，0.94-1.00；P=0.023）。
我们的研究结果表明，APN 可能在改善成人 ICU 患者的预后方面发挥重要作用。
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