接受血管活性药物治疗的重症监护患者：一项回顾性队列研究。
Intensive care patients receiving vasoactive medications: A retrospective cohort study.
机构信息
Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, 1 Gheringhap Street, Geelong, 3220, Australia; Eastern Health Centre for Quality and Patient Safety Research, Eastern Health Partnership, 5 Arnold Street, Box Hill, 3128, Victoria, Australia.
Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, 1 Gheringhap Street, Geelong, 3220, Australia.
出版信息
Aust Crit Care. 2022 Sep;35(5):499-505. doi: 10.1016/j.aucc.2021.07.003. Epub 2021 Sep 6.
BACKGROUND
Vasoactive medications are high-risk drugs commonly used in intensive care units (ICUs), which have wide variations in clinical management.
OBJECTIVES
The aim of this study was to describe the patient population, treatment, and clinical characteristics of patients who did and did not receive vasoactive medications while in the ICU and to develop a predictive tool to identify patients needing vasoactive medications.
METHODS
A retrospective cohort study of patients admitted to a level three tertiary referral ICU over a 12-month period from October 2018 to September 2019 was undertaken. Data from electronic medical records were analysed to describe patient characteristics in an adult ICU. Chi square and Mann-Whitney U tests were used to analyse data relating to patients who did and did not receive vasoactive medications. Univariate analysis and Pearson's r were used to determine inclusion in multivariable logistic regression.
RESULTS
Of 1276 patients in the cohort, 40% (512/1276) received a vasoactive medication for haemodynamic support, with 84% (428/512) receiving noradrenaline. Older patients (odds ratio [OR] = 1.02; 95% confidence interval [CI] = 1.01-1.02; p < 0.001) with higher Acute Physiology and Chronic Health Evaluation (APACHE) III scores (OR = 1.04; 95% CI = 1.03-1.04; p < 0.001) were more likely to receive vasoactive medications than those not treated with vasoactive medications during an intensive care admission. A model developed using multivariable analysis predicted that patients admitted with sepsis (OR = 2.43; 95% CI = 1.43-4.12; p = 0.001) or shock (OR = 4.05; 95% CI = 2.68-6.10; p < 0.001) and managed on mechanical ventilation (OR = 3.76; 95% CI = 2.81-5.02; p < 0.001) were more likely to receive vasoactive medications.
CONCLUSIONS
Mechanically ventilated patients admitted to intensive care for sepsis and shock with higher APACHE III scores were more likely to receive vasoactive medications. Predictors identified in the multivariable model can be used to direct resources to patients most at risk of receiving vasoactive medications.
背景
血管活性药物是重症监护病房（ICU）常用的高危药物，其临床管理存在广泛差异。
目的
本研究旨在描述 ICU 内接受和未接受血管活性药物治疗的患者人群、治疗和临床特征，并开发一种预测工具来识别需要血管活性药物治疗的患者。
方法
对 2018 年 10 月至 2019 年 9 月期间在三级转诊 ICU 住院的患者进行回顾性队列研究。对电子病历中的数据进行分析，以描述成人 ICU 患者的特征。卡方检验和曼-惠特尼 U 检验用于分析接受和未接受血管活性药物治疗的患者数据。单变量分析和 Pearson's r 用于确定多变量逻辑回归的纳入。
结果
在队列中的 1276 名患者中，40%（512/1276）接受了血管活性药物治疗以支持血流动力学，其中 84%（428/512）接受了去甲肾上腺素。年龄较大的患者（比值比[OR] 1.02；95%置信区间[CI] 1.01-1.02；p<0.001）和急性生理学和慢性健康评估（APACHE）III 评分较高的患者（OR 1.04；95%CI 1.03-1.04；p<0.001）在 ICU 住院期间更有可能接受血管活性药物治疗，而不是未接受血管活性药物治疗的患者。使用多变量分析建立的模型预测，患有败血症（OR 2.43；95%CI 1.43-4.12；p=0.001）或休克（OR 4.05；95%CI 2.68-6.10；p<0.001）且接受机械通气治疗（OR 3.76；95%CI 2.81-5.02；p<0.001）的患者更有可能接受血管活性药物治疗。
结论
因败血症和休克而接受机械通气治疗并具有较高 APACHE III 评分的 ICU 入院患者更有可能接受血管活性药物治疗。多变量模型中确定的预测因素可用于指导资源流向最有可能接受血管活性药物治疗的患者。
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