Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University in St. Louis, St. Louis, MO, United States.
Department of Medicine, University of Chicago, Chicago, IL, United States.
Resuscitation. 2018 Jul;128:191-197. doi: 10.1016/j.resuscitation.2018.05.013. Epub 2018 May 16.
Rapid response systems are commonly employed by hospitals to identify and respond to deteriorating patients outside of the intensive care unit. Controversy exists about the benefits of rapid response systems.
We aimed to review the current state of the rapid response literature, including evolving aspects of afferent (risk detection) and efferent (intervention) arms, outcome measurement, process improvement, and implementation.
Articles written in English and published in PubMed.
Rapid response systems are heterogeneous, with important differences among afferent and efferent arms. Clinically meaningful outcomes may include unexpected mortality, in-hospital cardiac arrest, length of stay, cost, and processes of care at end of life. Both positive and negative interventional studies have been published, although the two largest randomized trials involving rapid response systems - the Medical Early Response and Intervention Trial (MERIT) and the Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients (EPOCH) trial - did not find a mortality benefit with these systems, albeit with important limitations. Advances in monitoring technologies, risk assessment strategies, and behavioral ergonomics may offer opportunities for improvement.
Rapid responses may improve some meaningful outcomes, although these findings remain controversial. These systems may also improve care for patients at the end of life. Rapid response systems are expected to continue evolving with novel developments in monitoring technologies, risk prediction informatics, and work in human factors.
快速反应系统通常被医院用于识别和处理重症监护室外病情恶化的患者。关于快速反应系统的益处存在争议。
我们旨在回顾快速反应文献的现状，包括传入（风险检测）和传出（干预）臂、结果测量、流程改进和实施等方面的演变。
发表在 PubMed 上的英文文章。
快速反应系统具有异质性，传入和传出臂之间存在重要差异。有意义的临床结果可能包括意外死亡率、院内心搏骤停、住院时间、成本以及生命末期的护理流程。发表了阳性和阴性的干预性研究，尽管两项最大的涉及快速反应系统的随机试验——医疗早期反应和干预试验（MERIT）和儿科早期预警系统对住院儿科患者全因死亡率的影响（EPOCH）试验——并没有发现这些系统对死亡率有好处，但也存在重要的局限性。监测技术、风险评估策略和行为工效学的进步可能为改进提供机会。
快速反应可能会改善一些有意义的结果，但这些发现仍存在争议。这些系统也可能改善临终患者的护理。预计快速反应系统将随着监测技术、风险预测信息学和人类因素方面的新进展而不断发展。
