Kwack Won Gun, Yun Miae, Lee Dong Seon, Min Hyunju, Choi Yun Young, Lim Sung Yoon, Kim Youlim, Lee Sang Hoon, Lee Yeon Joo, Park Jong Sun, Cho Young-Jae
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine.
Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea.
Medicine (Baltimore). 2018 Nov;97(48):e13490. doi: 10.1097/MD.0000000000013490.
Critically ill patients could experience various risks including life-threatening events during intrahospital transportation (IHT), with a global incidence of 20% to 79.8%. Evidence on the clinical benefits of the presence of specialized intensive care members such as the rapid response team (RRT) during their transportation is limited. We aimed to elucidate the RRT's effectiveness in promoting patient's safety outcomes during transportation by comparing with those transport by general members.A single-center retrospective cohort study was conducted from January 2016 to February 2017, including critically ill patients admitted to the medical intensive care unit (ICU) due to respiratory failure under mechanical ventilation. Patients who underwent out-of-ICU transportation supported by RRT members, including a portable ventilator, were categorized as the RRT group, whereas those transported by general members, such as residents or interns, were the general group. Propensity score matching (PSM) was conducted due to several significant differences in the baseline characteristics between the 2 groups. Adverse events were defined as any situation requiring cardiopulmonary resuscitation (CPR), any physiologic deteriorations requiring immediate intervention or equipment dysfunctions.The median age of the 184 subjects included was 72 (inter quartile range, 62-75) years, and 114 (62.3%) of them were male. Thirty-six (19.6%) transports were supported by RRT, with significant higher APACHE II score than general groups (36.7 ± 6.0 vs 32.4 ± 7.7, P = .002). There was no critical event requiring CPR in both groups. However, adverse events were more frequently observed in the RRT than the general group (27.8% vs 8.1%, P = .001). PSM revealed insignificant difference in adverse events (26.7% vs 10.0%, P = .228).In critically ill patients in the medical ICU, IHT supported by the RRT did not show a more preventative effect on adverse events than that by the general group.
重症患者在院内转运（IHT）期间可能会经历各种风险，包括危及生命的事件，全球发生率为20%至79.8%。关于在转运过程中由快速反应团队（RRT）等专业重症监护人员陪同的临床益处的证据有限。我们旨在通过与普通人员护送的患者进行比较，阐明RRT在促进转运期间患者安全结果方面的有效性。
2016年1月至2017年2月进行了一项单中心回顾性队列研究，纳入因呼吸衰竭接受机械通气而入住内科重症监护病房（ICU）的重症患者。由RRT成员护送并配备便携式呼吸机进行ICU外转运的患者被归类为RRT组，而由住院医师或实习医师等普通人员护送的患者为普通组。由于两组基线特征存在若干显著差异，因此进行了倾向得分匹配（PSM）。不良事件定义为任何需要心肺复苏（CPR）的情况、任何需要立即干预的生理恶化或设备功能障碍。
纳入的184名受试者的中位年龄为72岁（四分位间距，62 - 75岁），其中114名（62.3%）为男性。36次（19.6%）转运由RRT护送，其急性生理与慢性健康状况评分系统（APACHE II）得分显著高于普通组（36.7 ± 6.0 vs 32.4 ± 7.7，P = 0.002）。两组均未发生需要CPR的危急事件。然而，RRT组比普通组更频繁地观察到不良事件（27.8% vs 8.1%，P = 0.001）。PSM显示不良事件无显著差异（26.7% vs 10.0%，P = 0.228）。
在内科ICU的重症患者中，RRT护送的IHT对不良事件的预防效果并不比普通组更显著。
