Dres Martin, Austin Peter C, Pham Tài, Aegerter Philippe, Guidet Bertrand, Demoule Alexandre, Vieillard-Baron Antoine, Brochard Laurent, Geri Guillaume
Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France.
Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale ("Département 'R3S'"), F-75013, Paris, France.
Crit Care Med. 2018 Jan;46(1):e33-e40. doi: 10.1097/CCM.0000000000002816.
To determine whether ICUs caring for higher volumes of acute respiratory distress syndrome patients would be associated with lower ICU mortality.
A 9-year multicenter retrospective cohort study of prospectively collected data.
French medical ICUs.
From 2004 to 2012, acute respiratory distress syndrome cases were identified from a coding system through a regional database (Collège des Utilisateurs de Données en Réanimation).
None.
Volume was calculated as the cumulative annual mean number of acute respiratory distress syndrome cases. Severity (Simplified Acute Physiology Score 2) and ICU mortality between categories (low, medium, and high) of acute respiratory distress syndrome cases volume were analyzed. Multivariable analysis using mixed effects models was performed to adjust for severity of illness and confounding factors. Over the study period, 8,383 acute respiratory distress syndrome patients among 31 ICUs met the study inclusion criteria. Overall, Simplified Acute Physiology Score 2 (median [interquartile]) was 58 (43-74), whereas ICU mortality was 53.7%. Severity as assessed by Simplified Acute Physiology Score 2 (median [interquartile]) was significantly higher in high-volume ICUs (> 65 acute respiratory distress syndrome per year) as compared to low (≤ 29 acute respiratory distress syndrome per year) and medium-volume ICUs (> 29-65 acute respiratory distress syndrome per year): 61 (46-77) versus 55 (41-72) and 55.0 (40-72), respectively (p < 0.01). ICU mortality was similar across the acute respiratory distress syndrome volume categories (53.6%, 54.1%, and 53.3% in low-, medium-, and high-volume categories ICUs, respectively). After adjustment for confounders, acute respiratory distress syndrome case volume was independently associated with ICU mortality (odds ratio for log-transformed volume: 0.77 [95% CI, 0.62-0.96]; p = 0.02).
ICUs caring for higher volumes of acute respiratory distress syndrome cases were associated with lower ICU mortality.
确定诊治急性呼吸窘迫综合征患者数量较多的重症监护病房（ICU）是否与较低的ICU死亡率相关。
一项对前瞻性收集的数据进行的9年多中心回顾性队列研究。
法国医疗ICU。
2004年至2012年，通过区域数据库（重症监护数据使用者学院）的编码系统识别急性呼吸窘迫综合征病例。
无。
量值计算为急性呼吸窘迫综合征病例的年度累积平均数。分析急性呼吸窘迫综合征病例量类别（低、中、高）之间的严重程度（简化急性生理学评分2）和ICU死亡率。采用混合效应模型进行多变量分析，以调整疾病严重程度和混杂因素。在研究期间，31个ICU中的8383例急性呼吸窘迫综合征患者符合研究纳入标准。总体而言，简化急性生理学评分2（中位数[四分位间距]）为58（43 - 74），而ICU死亡率为53.7%。与低量（每年≤29例急性呼吸窘迫综合征）和中等量（每年>29 - 65例急性呼吸窘迫综合征）ICU相比，高量ICU（每年>65例急性呼吸窘迫综合征）中通过简化急性生理学评分2评估的严重程度（中位数[四分位间距]）显著更高：分别为61（46 - 77）、55（41 - 72）和55.0（40 - 72）（p < 0.01）。各急性呼吸窘迫综合征病例量类别的ICU死亡率相似（低量、中等量和高量ICU类别分别为53.6%、54.1%和53.3%）。在调整混杂因素后，急性呼吸窘迫综合征病例量与ICU死亡率独立相关（对数转换量的比值比：0.77 [95% CI，0.62 - 0.96]；p = 0.02）。
诊治急性呼吸窘迫综合征病例数量较多的ICU与较低的ICU死亡率相关。
