Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, Virginia Commonwealth University, Box 980050, Richmond, VA, 23298-0050, USA.
Center for Adult Critical Care, Virginia Commonwealth University, Richmond, VA, USA.
Intensive Care Med. 2019 Nov;45(11):1559-1569. doi: 10.1007/s00134-019-05753-4. Epub 2019 Sep 17.
Prior studies have reported the adverse effects of strain on patient outcomes. There is a paucity of literature about a type of strain that may be caused by near-simultaneous intensive care unit (ICU) admissions. We hypothesized that when multiple admissions arrive nearly at the same time, the ICU teams are excessively strained, and this leads to unfavorable patient outcomes.
This is a retrospective cohort study of consecutive adult patients admitted to an academic medical ICU of a tertiary referral center over five consecutive years. Primary outcomes were the all-cause hospital and ICU mortality.
We enrolled 13,234 consecutive ICU admissions during the study period. One-fourth of the admissions had an elapsed time since the last admission (ETLA) of < 55 min. Near-simultaneous admissions (NSA) had on average, a higher unadjusted odds ratio (OR) of ICU death of 1.16 (95% CI 1-1.35, P = 0.05), adjusted 1.23 (95% CI 1.04-1.44, P = 0.01), unadjusted hospital death of 1.11 (95% CI 0.99-1.24, P = 0.06), adjusted 1.20 (95% 1.05-1.35, P = 0.004), and a lower adjusted OR of home discharge of 0.91 (95% CI 0.84-0.99, P = 0.04). NSA was associated with 0.16 (95% CI 0.04-0.29, P = 0.01) added days in the ICU. For each incremental unit increase of the logarithmic transformation of ETLA [log (ETLA in minutes)], the average adjusted hospital mortality OR incrementally decreased by an added average OR of 0.93 (95% CI 0.89‒0.97, P = 0.001).
Our results suggest that near-simultaneous ICU admissions (NSA) are frequent and are associated with a dose-dependent effect on mortality, length of stay, and odds of home versus nursing facility discharge.
先前的研究报告了应变对患者预后的不良影响。关于可能由重症监护病房（ICU）同时入院引起的一种应变类型，文献很少。我们假设，当多个入院几乎同时到达时，ICU 团队会承受过度的压力，这导致患者预后不良。
这是一项回顾性队列研究，连续纳入 5 年内入住一家三级转诊中心学术医疗 ICU 的成年患者。主要结局为全因院内和 ICU 死亡率。
在研究期间，我们共纳入了 13234 例连续 ICU 入院患者。四分之一的入院患者上次入院后的时间（ETLA）<55 分钟。近同时入院（NSA）的 ICU 死亡率的未调整优势比（OR）平均为 1.16（95%CI 1-1.35，P=0.05），调整后为 1.23（95%CI 1.04-1.44，P=0.01），未调整的院内死亡率为 1.11（95%CI 0.99-1.24，P=0.06），调整后为 1.20（95%CI 1.05-1.35，P=0.004），出院回家的调整后 OR 为 0.91（95%CI 0.84-0.99，P=0.04）。NSA 与 ICU 住院天数增加 0.16（95%CI 0.04-0.29，P=0.01）相关。对于 ETLA 的对数变换[log（ETLA 以分为单位）]每增加一个单位，平均调整后的院内死亡率 OR 平均增加 0.93（95%CI 0.89-0.97，P=0.001）。
我们的研究结果表明，近同时 ICU 入院（NSA）很常见，并且与死亡率、住院时间以及出院回家或护理机构的几率呈剂量依赖性相关。
