Fazzini Brigitta, Nourse Simon, McGinley Ann
Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, UK.
Nurs Crit Care. 2023 May;28(3):427-434. doi: 10.1111/nicc.12772. Epub 2022 Apr 5.
Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak, the Critical Care Outreach Team (CCOT) remained operational to provide critical care support to acutely ill and deteriorating patients on the wards.
We aimed to evaluate the demand and efficacy of the critical care outreach service during the COVID-19 pandemic.
We prospectively evaluated all patients referred to critical care outreach enrolled during a twelve-month period. We reported the cumulative number of activities and interventions and baseline characteristics, acuity level and patients' clinical outcome. The rate of ICU admissions, activity plan, patients' acuity and mortality are compared to historical data pre-pandemic.
Amongst 4849 patients referred, 3913 had a clinical review and of those 895 were COVID-19 positive. Non-invasive ventilation was mostly delivered to COVID-19 patients (COVID-19 +VE: 853/895, 95% vs. COVID-19 -VE: 119/3018, 4%) alongside awake prone positioning (COVID-19 +VE: 232/895, 26% vs. COVID-19 -VE: 0/3018, 0%). Compared to pre-pandemic, the cumulative number of patients assessed increased (observed: 3913 vs. historical: 3615; p = 0.204), patients meeting Level 2 acuity were higher (observed: 51% vs. historical: 21%; p = 0.003), but ICU admission rate did not increase significantly (observed: 12% vs. historical: 9%; p = 0.065), and greater mortality rate (observed: 14% vs. historical: 8%; p = 0.046) was observed.
Critical care outreach bridges the gap between the intensive care unit and general wards and supports the concept of 'critical care without walls' acting as a valuable resource in optimizing and triaging acutely unwell patients and potentially averting critical care admissions.
The COVID-19 pandemic has generated an unprecedented surge of deteriorating and critically ill patients with has caused severe and sustained pressures on intensive care units (ICUs) and general wards. Acutely ill patients can deteriorate quickly, and early recognition is vital to commence critical intervention on the wards or transfer timely to ICU. The Critical Care Outreach Team can help staff and optimize acutely ill and deteriorating patients by providing timely critical care interventions at the patient bedside.
自2019年冠状病毒病（COVID-19）疫情爆发以来，重症监护外展团队（CCOT）一直保持运作，为病房中病情严重和病情恶化的患者提供重症监护支持。
我们旨在评估COVID-19大流行期间重症监护外展服务的需求和效果。
我们前瞻性地评估了在12个月期间转诊至重症监护外展服务的所有患者。我们报告了活动和干预措施的累计数量以及基线特征、 acuity水平和患者的临床结局。将ICU入院率、活动计划、患者 acuity和死亡率与疫情前的历史数据进行比较。
在4849名转诊患者中，3913名接受了临床评估，其中895名COVID-19呈阳性。无创通气主要用于COVID-19患者（COVID-19阳性：853/895，95% 对比COVID-19阴性：119/3018，4%），同时还有清醒俯卧位（COVID-19阳性：232/895，26% 对比COVID-19阴性：0/3018，0%）。与疫情前相比，评估的患者累计数量有所增加（观察值：3913对比历史值：3615；p = 0.204），达到2级 acuity的患者比例更高（观察值：51%对比历史值：21%；p = 0.003），但ICU入院率没有显著增加（观察值：12%对比历史值：9%；p = 0.065），且观察到更高的死亡率（观察值：14%对比历史值：8%；p = 0.046）。
重症监护外展服务弥合了重症监护病房和普通病房之间的差距，支持了“无墙重症监护”的概念，在优化和分诊急性不适患者以及可能避免重症监护入院方面发挥了宝贵资源的作用。
COVID-19大流行导致病情恶化和重症患者数量前所未有的激增，给重症监护病房（ICU）和普通病房带来了严重且持续的压力。急性病患者病情可能迅速恶化，早期识别对于在病房开始关键干预或及时转至ICU至关重要。重症监护外展团队可以通过在患者床边提供及时的重症监护干预措施来帮助医护人员并优化急性病和病情恶化的患者。
