法国在新冠疫情期间为应对重症监护病房床位激增而进行的危重症患者院际转运。
Inter-hospital transport of critically ill patients to manage the intensive care unit surge during the COVID-19 pandemic in France.
作者信息
Painvin Benoit, Messet Hélène, Rodriguez Maeva, Lebouvier Thomas, Chatellier Delphine, Soulat Louis, Ehrmann Stephane, Thille Arnaud W, Gacouin Arnaud, Tadie Jean-Marc
机构信息
Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.
Service de Médecine Intensive et Réanimation, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2, boulevard Tonnellé, 27044, Tours cedex 9, France.
出版信息
Ann Intensive Care. 2021 Mar 31;11(1):54. doi: 10.1186/s13613-021-00841-5.
BACKGROUND
The COVID-19 pandemic led authorities to evacuate via various travel modalities critically ill ventilated patients into less crowded units. However, it is not known if interhospital transport impacts COVID-19 patient's mortality in intensive care units (ICUs). A cohort from three French University Hospitals was analysed in ICUs between 15th of March and the 15th of April 2020. Patients admitted to ICU with positive COVID-19 test and mechanically ventilated were recruited.
RESULTS
Among the 133 patients included in the study, 95 (71%) were male patients and median age was 63 years old (interquartile range: 54-71). Overall ICU mortality was 11%. Mode of transport included train (48 patients), ambulance (6 patients), and plane plus helicopter (14 patients). During their ICU stay, 7 (10%) transferred patients and 8 (12%) non-transferred patients died (p = 0.71). Median SAPS II score at admission was 33 (interquartile range: 25-46) for the transferred group and 35 (27-42) for non-transferred patients (p = 0.53). SOFA score at admission was 4 (3-6) for the transferred group versus 3 (2-5) for the non-transferred group (p = 0.25). In the transferred group, median PaO/FiO ratio (P/F) value in the 24 h before departure was 197 mmHg (160-250) and remained 166 mmHg (125-222) in the first 24 h post arrival (p = 0.13). During the evacuation 46 (68%) and 21 (31%) of the patients, respectively, benefited from neuromuscular blocking agents and from vasopressors. Transferred and non-transferred patients had similar rate of nosocomial infections, 37/68 (54%) versus 34/65 (52%), respectively (p = 0.80). Median length of mechanical ventilation was significantly increased in the transferred group compared to the non-transferred group, 18 days (11-24) and 14 days (8-20), respectively (p = 0.007). Finally, ICU and hospital length of stay did not differ between groups.
CONCLUSIONS
In France, inter-hospital evacuation of COVID-19 ventilated ICU patients did not appear to increase mortality and therefore could be proposed to manage ICU surges in the future.
背景
新冠疫情致使当局通过多种交通方式，将重症机械通气患者转移至人员密度较低的病房。然而，院际转运对重症监护病房（ICU）中新冠患者死亡率的影响尚不清楚。对法国三家大学医院的一个队列进行了分析，研究对象为2020年3月15日至4月15日期间入住ICU的患者。纳入的患者为新冠病毒检测呈阳性且接受机械通气的ICU患者。
结果
在纳入研究的133例患者中，95例（71%）为男性，中位年龄为63岁（四分位间距：54 - 71岁）。ICU总体死亡率为11%。转运方式包括火车（48例患者）、救护车（6例患者）以及飞机加直升机（14例患者）。在ICU住院期间，7例（10%）转运患者和8例（12%）未转运患者死亡（p = 0.71）。转运组入院时的中位简化急性生理学评分（SAPS II）为33（四分位间距：25 - 46），未转运患者为35（27 - 42）（p = 0.53）。转运组入院时的序贯器官衰竭评估（SOFA）评分为4（3 - 6），未转运组为3（2 - 5）（p = 0.25）。在转运组中，出发前24小时的中位动脉血氧分压/吸入氧浓度比值（P/F）为197 mmHg（160 - 250），到达后的最初24小时仍为166 mmHg（125 - 222）（p = 0.13）。在转运过程中，分别有46例（68%）和21例（3l%）患者使用了神经肌肉阻滞剂和血管活性药物。转运患者和未转运患者的医院感染率相似，分别为37/68（54%）和34/65（52%）（p = 0.80）。与未转运组相比，转运组的机械通气中位时长显著延长，分别为18天（11 - 24天）和14天（8 - 20天）（p = 0.007）。最后，两组间的ICU住院时长和住院总时长无差异。
结论
在法国，对新冠机械通气ICU患者进行院际转运似乎并未增加死亡率，因此未来可考虑用于应对ICU床位紧张的情况。
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