Okawa Reiko, Yokono Tomoe, Koyama Yu, Uchiyama Mieko, Oono Naoko
Emergency and Critical Care Center, Nagaoka Red Cross Hospital, Nagaoka 940-2085, Japan.
Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata 951-8518, Japan.
Medicina (Kaunas). 2021 Nov 2;57(11):1194. doi: 10.3390/medicina57111194.
: For effective function of the rapid response system (RRS), prompt identification of patients at a high risk of cardiac arrest and RRS activation without hesitation are important. This study aimed to identify clinical factors that increase the risk of intensive care unit (ICU) transfer and cardiac arrest to identify patients who are likely to develop serious conditions requiring ICU management and appropriate RRS activation in Japan. : We performed a single-center, case control study among patients requiring a rapid response team (RRT) call from 2017 to 2020. We extracted the demographic data, vital parameters, blood oxygen saturation (SpO) and the fraction of inspired oxygen (FiO) from the medical records at the time of RRT call. The patients were divided into two groups to identify clinical signs that correlated with the progression of clinical deterioration. Patient characteristics in the two groups were compared using statistical tests based on the distribution. Receiver operating characteristic (ROC) curve analysis was used to identify the appropriate cut-off values of vital parameters or FiO that showed a significant difference between-group. Multivariate logistic regression analysis was used to identify patient factors that were predictive of RRS necessity. : We analyzed the data of 65 patients who met our hospital's RRT call criteria. Among the clinical signs in RRT call criteria, respiratory rate (RR) ( < 0.01) and the needed FiO were significantly increased ( < 0.01) in patients with severe disease course. ROC curve analysis revealed RR and needed FiO cut-off values of 25.5 breaths/min and 30%. The odds ratio for the progression of clinical deterioration was 40.5 times higher with the combination of RR ≥ 26 breaths/min and needed FiO ≥ 30%. : The combined use of RR ≥ 26 breaths/min and needed FiO ≥ 30% might be valid for identifying patients requiring intensive care management.
对于快速反应系统（RRS）的有效运作，迅速识别心脏骤停高危患者并毫不犹豫地激活RRS至关重要。本研究旨在确定增加重症监护病房（ICU）转诊和心脏骤停风险的临床因素，以识别在日本可能发展为需要ICU管理的严重病情并进行适当RRS激活的患者。：我们在2017年至2020年期间对需要快速反应团队（RRT）呼叫的患者进行了一项单中心病例对照研究。我们从RRT呼叫时的病历中提取了人口统计学数据、生命体征参数、血氧饱和度（SpO）和吸入氧分数（FiO）。将患者分为两组，以识别与临床病情恶化进展相关的临床体征。基于分布情况，使用统计检验比较两组患者的特征。采用受试者操作特征（ROC）曲线分析来确定两组间有显著差异的生命体征参数或FiO的合适临界值。使用多变量逻辑回归分析来确定预测RRS必要性的患者因素。：我们分析了65例符合我院RRT呼叫标准的患者数据。在RRT呼叫标准中的临床体征中，病情严重的患者呼吸频率（RR）（<0.01）和所需FiO显著升高（<0.01）。ROC曲线分析显示RR和所需FiO的临界值分别为25.5次/分钟和30%。RR≥26次/分钟且所需FiO≥30%联合出现时，临床病情恶化进展的优势比高40.5倍。：RR≥26次/分钟和所需FiO≥30%联合使用可能对识别需要重症监护管理的患者有效。
