法国医院获得性肺炎预防与治疗建议的实施：一项整群随机试验

Implementation of French Recommendations for the Prevention and the Treatment of Hospital-acquired Pneumonia: A Cluster-randomized Trial.

作者信息

Roquilly Antoine, Chanques Gérald, Lasocki Sigismond, Foucrier Arnaud, Fermier Brice, De Courson Hugues, Carrie Cedric, Danguy des Deserts Marc, Gakuba Clément, Constantin Jean-Michel, Lagarde Kevin, Holleville Mathilde, Blidi Sami, Sossou Achille, Cailliez Pauline, Monard Celine, Oudotte Adrien, Mathieu Calypso, Bourenne Jeremy, Isetta Christian, Perrigault Pierre-François, Lakhal Karim, Rouhani Armine, Asehnoune Karim, Guerci Philippe, Tran Dinh Alexy, Chousterman Benjamin, Cupaciu Alexandru, Dahyot-Fizelier Claire, Bellier Remy, Au Duong Jonathan, Mansour Alexandre, Morel Jérome, Beauplet Ghilain, Vibet Marie-Anne, Feuillet Fanny, Sébille Véronique, Leone Marc

机构信息

Department of Anesthesiology and Critical Care, Hotel Dieu, Centre Hospitalier Universitaire Nantes, Nantes, France.

Laboratory EA3826, Faculty of Medicine, University of Nantes, Nantes, France.

出版信息

Clin Infect Dis. 2021 Oct 5;73(7):e1601-e1610. doi: 10.1093/cid/ciaa1441.

DOI:10.1093/cid/ciaa1441

PMID:32970811

Abstract

BACKGROUND

We determined whether an audit on the adherence to guidelines for hospital-acquired pneumonia (HAP) can improve the outcomes of patients in intensive care units (ICUs).

METHODS

This study was conducted at 35 ICUs in 30 hospitals. We included consecutive, adult patients hospitalized in ICUs for 3 days or more. After a 3-month baseline period followed by the dissemination of recommendations, an audit on the compliance to recommendations (audit period) was followed by a 3-month cluster-randomized trial. We randomly assigned ICUs to either receive audit and feedback (intervention group) or participate in a national registry (control group). The primary outcome was the duration of ICU stay.

RESULTS

Among 1856 patients enrolled, 602, 669, and 585 were recruited in the baseline, audit, and intervention periods, respectively. The composite measures of compliance were 47% (interquartile range [IQR], 38-56%) in the intervention group and 42% (IQR, 25-53%) in the control group (P = .001). As compared to the baseline period, the ICU lengths of stay were reduced by 3.2 days in the intervention period (P = .07) and by 2.8 days in the control period (P = .02). The durations of ICU stay were 7 days (IQR, 5-14 days) in the control group and 9 days (IQR, 5-20 days) in the intervention group (P = .10). After adjustment for unbalanced baseline characteristics, the hazard ratio for being discharged alive from the ICU in the control group was 1.17 (95% confidence interval, .69-2.01; P = .10).

CONCLUSIONS

The publication of French guidelines for HAP was associated with a reduction of the ICU length of stay. However, the realization of an audit to improve their application did not further improve outcomes.

CLINICAL TRIALS REGISTRATION

NCT03348579.

摘要

背景

我们确定了一项关于医院获得性肺炎（HAP）指南依从性的审核是否能改善重症监护病房（ICU）患者的治疗结果。

方法

本研究在30家医院的35个ICU进行。我们纳入了在ICU住院3天或更长时间的连续成年患者。在为期3个月的基线期之后进行建议的传播，接着是对建议依从性的审核（审核期），之后是为期3个月的整群随机试验。我们将ICU随机分为接受审核和反馈的组（干预组）或参与国家登记的组（对照组）。主要结局是ICU住院时间。

结果

在纳入的1856例患者中，分别有602例、669例和585例在基线期、审核期和干预期入组。干预组的综合依从性指标为47%（四分位间距[IQR]，38 - 56%），对照组为42%（IQR，25 - 53%）（P = .001）。与基线期相比，干预期的ICU住院时间减少了3.2天（P = .07），对照期减少了2.8天（P = .02）。对照组的ICU住院时间为7天（IQR，5 - 14天），干预组为9天（IQR，5 - 20天）（P = .10）。在对不平衡的基线特征进行调整后，对照组从ICU存活出院的风险比为1.17（95%置信区间，.69 - 2.01；P = .10）。