Amas Gómez L, Zubia Olaskoaga F
Servicio de Medicina Intensiva, Hospital Universitario Donostia, OSI Donostialdea, San Sebastián, Guipúzcoa, España.
Servicio de Medicina Intensiva, Departamento de Medicina, Hospital Universitario Donostia, OSI Donostialdea, Euskal Herriko Unibertsitatea/Universidad del País Vasco (UPV-EHU), San Sebastián, Guipúzcoa, España.
Med Intensiva (Engl Ed). 2019 Dec;43(9):546-555. doi: 10.1016/j.medin.2018.05.004. Epub 2018 Jul 30.
To determine whether the implementation of a protocol for the management of patients with acute pancreatitis (AP) in an Intensive Care Unit (ICU) improves the clinical outcomes.
A retrospective, before-after observational case series study was carried out.
1 January 2001 to 31 December 2016, divided in 2 periods (pre-protocol 2001-2007, post-protocol 2008-2016).
An ICU with 48 beds and a recruitment population of 700,000 inhabitants.
AP patients admitted to the ICU, with no exclusion criteria.
The recommendations proposed in the 7th Consensus Conference of the SEMICYUC on AP (5 September 2007) were applied in the second period.
Patient age, sex, APACHE II, SOFA, study period, pre-ICU hospital stay, nutrition, surgery, antibiotic prophylaxis, hospital mortality, ICU length of stay, hospital length of stay, determinant-based classification.
The study comprised 286 patients (94 in the pre-protocol period, 192 in the post-protocol period), with a global in-hospital mortality rate of 23.1% (n=66). Application of the protocol decreased the pre-ICU hospital stay and the use of antibiotic prophylaxis, and increased the use of enteral nutrition. Hospital mortality decreased in the second period (35.1 vs. 17.18%; P=.001), with no significant changes in ICU and hospital stays. In the multivariate logistic regression analysis, the variable period of treatment remained as a variable of statistical significance in terms of hospital mortality (OR 0.34 for the period 2008-2016, 95% CI 0.15-0.74).
The implementation of a protocol could result in decreased mortality among AP patients admitted to the ICU.
确定在重症监护病房（ICU）实施急性胰腺炎（AP）患者管理方案是否能改善临床结局。
开展一项回顾性前后观察性病例系列研究。
2001年1月1日至2016年12月31日，分为两个时期（方案实施前，2001 - 2007年；方案实施后，2008 - 2016年）。
一家拥有48张床位且服务人口达70万居民的ICU。
入住ICU的AP患者，无排除标准。
在第二个时期应用了西班牙重症监护与冠心病学会（SEMICYUC）第七届AP共识会议（2007年9月5日）提出的建议。
患者年龄、性别、急性生理与慢性健康状况评分系统II（APACHE II）、序贯器官衰竭评估（SOFA）、研究时期、入住ICU前的住院时间、营养状况、手术情况、抗生素预防使用、医院死亡率、ICU住院时长、医院住院时长、基于决定因素的分类。
该研究纳入286例患者（方案实施前期94例，方案实施后期192例），总体院内死亡率为23.1%（n = 66）。方案的应用缩短了入住ICU前的住院时间并减少了抗生素预防使用，同时增加了肠内营养的使用。第二个时期医院死亡率下降（35.1%对17.18%；P = 0.001），ICU和医院住院时长无显著变化。在多因素逻辑回归分析中，治疗时期变量在医院死亡率方面仍具有统计学意义（2008 - 2016年时期的比值比为0.34，95%置信区间为0.15 - 0.74）。
实施一项方案可能会降低入住ICU的AP患者的死亡率。
