Jung Minyoung, Park Hyejeong, Kang Danbee, Park Esther, Jeon Kyeongman, Chung Chi Ryang, Yang Jeong Hoon, Suh Gee Young, Guallar Eliseo, Cho Juhee, Cho Joongbum
Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Republic of Korea.
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Ann Intensive Care. 2020 Nov 30;10(1):159. doi: 10.1186/s13613-020-00780-7.
Despite the high workload of mechanical ventilation, there has been a lack of studies on the association between nurse workforce and mortality in mechanically ventilated patients. We evaluated the association of the bed-to-nurse ratio with mortality in ventilated pediatric patients admitted to an intensive care unit (ICU).
We conducted a nationwide retrospective analysis by using the Korean National Health Insurance database, which categorizes the bed-to-nurse ratio into 9 grades according to the number of beds divided by the number of full-time equivalent registered nurses in a unit. Patients of ages between 28 days and 18 years were enrolled. Multiple admissions and transfers from other hospitals were excluded. We evaluated the odds ratios (ORs) of in-hospital mortality using 4 groups (Grade 1: bed-to-nurse < 0.50, Grade 2: < 0.63, Grade 3: < 0.77, Grade 4 or above > 0.77) with adjustment of patient factors, hospital factors, and treatment requirements.
Of the 27,849 patients admitted to ICU, 11,628 (41.8%) were on mechanical ventilation. The overall in-hospital mortality rates in Grade 1, Grade 2, Grade 3, and Grade 4 or above group were 4.5%, 6.8%, 6.9%, and 4.7%, respectively. The adjusted ORs (95% CI) for in-hospital mortality of mechanically ventilated patients in the Grade 2, Grade 3, and Grade 4 or above compared to those in Grade 1 were 2.73 (95% CI 1.51-4.95), 4.02 (95% CI 2.23-7.26), and 7.83 (4.07-15.07), respectively. However, for patients without mechanical ventilation, the adjusted ORs of in-hospital mortality were not statistically significant.
In mechanically ventilated patients, the adjusted mortality rate increased significantly, as the bed-to-nurse ratio of the ICU increased. Policies that limit the number of ventilated patients per nurse should be considered. Trial registration retrospectively registered.
尽管机械通气的工作量很大，但关于护士人力与机械通气患者死亡率之间的关联研究却很缺乏。我们评估了重症监护病房（ICU）中接受通气治疗的儿科患者的床护比与死亡率之间的关联。
我们利用韩国国民健康保险数据库进行了一项全国性回顾性分析，该数据库根据一个科室的床位数除以全职等效注册护士人数，将床护比分为9个等级。纳入年龄在28天至18岁之间的患者。排除多次入院和从其他医院转来的患者。我们使用4组（1级：床护比<0.50，2级：<0.63，3级：<0.77，4级及以上：>0.77）评估院内死亡率的比值比（OR），并对患者因素、医院因素和治疗需求进行了调整。
在入住ICU的27849例患者中，11628例（41.8%）接受了机械通气。1级、2级、3级和4级及以上组的总体院内死亡率分别为4.5%、6.8%、6.9%和4.7%。与1级相比，2级、3级和4级及以上机械通气患者院内死亡的调整后OR（95%CI）分别为2.73（95%CI 1.51 - 4.95）、4.02（95%CI 2.23 - 7.26）和7.83（4.07 - 15.07）。然而，对于未接受机械通气的患者，院内死亡的调整后OR无统计学意义。
在机械通气患者中，随着ICU床护比的增加，调整后的死亡率显著上升。应考虑限制每名护士护理通气患者数量的政策。回顾性注册试验。
