Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
Biomed J. 2017 Aug;40(4):226-231. doi: 10.1016/j.bj.2017.06.005. Epub 2017 Jul 27.
Patients with severe sepsis frequently require intensive care unit (ICU) admission and different ICU care models may influence their outcomes. The mortality of severe septic patients between physician's high and low care volume remains unclear.
We analyzed the data from a three-year prospective observation study, which was performed in an adult medical ICU of Chung Gung Memorial Hospital, Keelung. The data included initial bundle therapies based on the Surviving Sepsis Campaign (SSC) guidelines for patients with severe sepsis.
Clinical data of total 484 patients with severe sepsis were recorded. Cox regression model showed that physician's care volume was an independent factor for lowering mortality in ICU patients with severe sepsis (hazard ratio 0.708; 95% confidence interval 0.514-0.974; p = 0.034). Patients treated by high care volume physician had four out of nine bundle therapies that were significantly higher in percentage following the SSC guidelines. These four therapies were renal replacement therapy, administration of low-dose steroids for septic shock, prophylaxis of gastro-intestinal bleeding, and control of hyperglycemia.
High care volume physician may decrease mortality in ICU patients with severe sepsis through fitting bundle therapies for sepsis.
严重脓毒症患者常需要入住重症监护病房（ICU），不同的 ICU 护理模式可能会影响他们的预后。高医疗量医生和低医疗量医生治疗的严重脓毒症患者的死亡率尚不清楚。
我们分析了一项为期三年的前瞻性观察研究的数据，该研究在基隆长庚纪念医院的成人内科 ICU 进行。数据包括根据严重脓毒症生存运动（SSC）指南对严重脓毒症患者进行的初始捆绑治疗。
共记录了 484 例严重脓毒症患者的临床数据。Cox 回归模型显示，医生的护理量是 ICU 严重脓毒症患者降低死亡率的独立因素（危险比 0.708；95%置信区间 0.514-0.974；p=0.034）。高护理量医生治疗的患者有九项捆绑治疗中的四项，符合 SSC 指南的比例显著更高，这四项治疗分别是肾替代治疗、脓毒性休克时给予低剂量类固醇、预防胃肠出血和控制高血糖。
高护理量医生可能通过为脓毒症患者提供合适的捆绑治疗来降低 ICU 中严重脓毒症患者的死亡率。
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