Michetti Christopher P, Fakhry Samir M, Brasel Karen, Martin Niels D, Teicher Erik J, Newcomb Anna
Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.
Surgery, Reston Hospital Center, Reston, Virginia, USA.
Trauma Surg Acute Care Open. 2019 Feb 18;4(1):e000288. doi: 10.1136/tsaco-2018-000288. eCollection 2019.
Surgical critical care is crucial to the care of trauma and surgical patients. This study was designed to provide a contemporary assessment of patient types, injuries, and conditions in intensive care units (ICU) caring for trauma patients.
This was a multicenter prevalence study of the American Association for the Surgery of Trauma; data were collected on all patients present in participating centers' trauma ICU (TICU) on November 2, 2017 and April 10, 2018.
Forty-nine centers submitted data on 1416 patients. Median age was 58 years (IQR 41-70). Patient types included trauma (n=665, 46.9%), non-trauma surgical (n=536, 37.8%), medical (n=204, 14.4% overall), or unspecified (n=11). Surgical intensivists managed 73.1% of patients. Of ICU-specific diagnoses, 57% were pulmonary related. Multiple high-intensity diagnoses were represented (septic shock, 10.2%; multiple organ failure, 5.58%; adult respiratory distress syndrome, 4.38%). Hemorrhagic shock was seen in 11.6% of trauma patients and 6.55% of all patients. The most common traumatic injuries were rib fractures (41.6%), brain (38.8%), hemothorax/pneumothorax (30.8%), and facial fractures (23.7%). Forty-four percent were on mechanical ventilation, and 17.6% had a tracheostomy. One-third (33%) had an infection, and over half (54.3%) were on antibiotics. Operations were performed in 70.2%, with 23.7% having abdominal surgery. At 30 days, 5.4% were still in the ICU. Median ICU length of stay was 9 days (IQR 4-20). 30-day mortality was 11.2%.
Patient acuity in TICUs in the USA is very high, as is the breadth of pathology and the interventions provided. Non-trauma patients constitute a significant proportion of TICU care. Further assessment of the global predictors of outcome is needed to inform the education, research, clinical practice, and staffing of surgical critical care providers.
IV, prospective observational study.
外科重症监护对于创伤和外科手术患者的护理至关重要。本研究旨在对重症监护病房（ICU）中创伤患者的患者类型、损伤及病情进行当代评估。
这是一项美国创伤外科协会的多中心患病率研究；收集了2017年11月2日和2018年4月10日参与中心创伤ICU（TICU）内所有患者的数据。
49个中心提交了1416例患者的数据。中位年龄为58岁（四分位间距41 - 70岁）。患者类型包括创伤患者（n = 665，46.9%）、非创伤外科患者（n = 536，37.8%）、内科患者（总体n = 204，14.4%）或未明确分类患者（n = 11）。外科重症监护医师管理了73.1%的患者。在ICU特定诊断中，57%与肺部相关。存在多种高强度诊断（感染性休克，10.2%；多器官功能衰竭，5.58%；成人呼吸窘迫综合征，4.38%）。11.6%的创伤患者和6.55%的所有患者出现失血性休克。最常见的创伤性损伤为肋骨骨折（41.6%）、脑部损伤（38.8%）、血胸/气胸（30.8%）和面骨骨折（23.7%）。44%的患者接受机械通气，17.6%的患者行气管切开术。三分之一（33%）的患者发生感染，超过半数（半数以上，54.3%）的患者使用抗生素。70.2%的患者接受了手术，其中23.7%接受了腹部手术。在30天时，5.4%的患者仍在ICU。ICU中位住院时间为9天（四分位间距4 - 20天）。30天死亡率为11.2%。
美国TICU中的患者病情严重程度很高，病理范围和所提供的干预措施也是如此。非创伤患者占TICU护理的很大比例。需要进一步评估结局的总体预测因素，以为外科重症监护提供者的教育、研究、临床实践和人员配备提供信息。
IV，前瞻性观察性研究。
