Reynolds H N, Haupt M T, Thill-Baharozian M C, Carlson R W
Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI.
JAMA. 1988 Dec 16;260(23):3446-50.
To evaluate the effects of reorganizing physician resources in a medical intensive care unit (MICU), we studied the impact of these changes in patients with septic shock. Patients were compared during two consecutive 12-month periods: (1) an interval in which faculty without critical care medicine (CCM) training supervised the MICU (before CCM, n = 100) and (2) following staffing with physicians formally trained in CCM (after CCM, n = 112). Acute Physiology and Chronic Health Evaluation scores were utilized to compare severity of illness and were similar for each group (29 +/- 11 before CCM vs 28 +/- 10 after CCM). However, mortality was significantly lower during the post-CCM interval (74% vs 57%, respectively). There was no significant difference in the frequency of use of mechanical ventilation (83% vs 87%), although pulmonary artery catheters (48% vs 64%) and arterial catheters (24% vs 73%) were employed more frequently after CCM. The number of subspecialty consultations and MICU and hospital length of stay were similar for both intervals. We conclude that the implementation of dedicated staffing by CCM physicians in a university hospital MICU was associated with a favorable impact on patients with septic shock.
为评估在医学重症监护病房（MICU）重组医师资源的效果，我们研究了这些变化对感染性休克患者的影响。在连续两个12个月期间对患者进行比较：（1）由未接受重症医学（CCM）培训的教员监督MICU的时间段（CCM之前，n = 100），以及（2）配备经过CCM正规培训的医师之后的时间段（CCM之后，n = 112）。采用急性生理与慢性健康评估评分来比较疾病严重程度，两组相似（CCM之前为29±11，CCM之后为28±10）。然而，CCM之后的时间段死亡率显著更低（分别为74%和57%）。机械通气的使用频率无显著差异（83%对87%），尽管CCM之后肺动脉导管（48%对64%）和动脉导管（24%对73%）的使用更为频繁。两个时间段的专科会诊次数、MICU住院时间和住院总时长相似。我们得出结论，在大学医院MICU实施由CCM医师进行专门人员配备对感染性休克患者有积极影响。
