Lee Ju-Ry, Jung Youn-Kyung, Hong Sang-Bum, Huh Jin Won
Department of Nursing, Geoje University, 91, Majeon 1-gil, Geoje 53325, Korea.
Medical Emergency Team, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
J Clin Med. 2022 Mar 21;11(6):1736. doi: 10.3390/jcm11061736.
Recurrent clinical deterioration and repeat medical emergency team (MET) activation are common and associated with high in-hospital mortality. This study assessed the predictors for repeat MET activation in deteriorating patients admitted to a general ward. We retrospectively analyzed the data of 5512 consecutive deteriorating hospitalized adult patients who required MET activation in the general ward. The patients were divided into two groups according to repeat MET activation. Multivariate logistic regression analyses were used to identify the predictors for repeat MET activation. Hematological malignancies (odds ratio, 2.07; 95% confidence interval, 1.54-2.79) and chronic lung disease (1.49; 1.07-2.06) were associated with a high risk of repeat MET activation. Among the causes for MET activation, respiratory distress (1.76; 1.19-2.60) increased the risk of repeat MET activation. A low oxygen saturation-to-fraction of inspired oxygen ratio (0.97; 0.95-0.98), high-flow nasal cannula oxygenation (4.52; 3.56-5.74), airway suctioning (4.63; 3.59-5.98), noninvasive mechanical ventilation (1.52; 1.07-2.68), and vasopressor support (1.76; 1.22-2.54) at first MET activation increased the risk of repeat MET activation. The risk factors identified in this study may be useful to identify patients at risk of repeat MET activation at the first MET activation. This would allow the classification of high-risk patients and the application of aggressive interventions to improve outcomes.
临床病情反复恶化以及重复启动医疗急救团队（MET）的情况很常见，且与院内高死亡率相关。本研究评估了普通病房中病情恶化患者重复启动MET的预测因素。我们回顾性分析了普通病房中5512例连续住院的病情恶化且需要启动MET的成年患者的数据。根据是否重复启动MET将患者分为两组。采用多因素逻辑回归分析来确定重复启动MET的预测因素。血液系统恶性肿瘤（比值比，2.07；95%置信区间，1.54 - 2.79）和慢性肺部疾病（1.49；1.07 - 2.06）与重复启动MET的高风险相关。在启动MET的原因中，呼吸窘迫（1.76；1.19 - 2.60）会增加重复启动MET的风险。首次启动MET时低氧饱和度与吸入氧分数比值（0.97；0.95 - 0.98）、高流量鼻导管给氧（4.52；3.56 - 5.74）、气道吸引（4.63；3.59 - 5.98）、无创机械通气（1.52；1.07 - 2.68）以及血管活性药物支持（1.76；1.22 - 2.54）会增加重复启动MET的风险。本研究中确定的危险因素可能有助于在首次启动MET时识别有重复启动MET风险的患者。这将有助于对高危患者进行分类，并应用积极的干预措施来改善预后。
