O Saggaf Ahmed Mihdhar, Mugharbel Abdullah, Aboalola Abdulrahman, Mulla Albarra, Alasiri Meshal, Alabbasi Muhannad, Bakhsh Abdullah
Department of Emergency Medicine, King Abdulaziz University, Jeddah, SAU.
Faculty of Medicine, King Abdulaziz University, Jeddah, SAU.
Cureus. 2022 Apr 9;14(4):e23990. doi: 10.7759/cureus.23990. eCollection 2022 Apr.
Background and objective The boarding of critically ill patients in the emergency department (ED) has been on the rise over the past few years. Emergency physicians now frequently encounter critically ill patients who require rapid resuscitation and stabilization and they provide extended care in the ED. This study aimed to evaluate the association between the boarding duration of mechanically ventilated patients in the ED and outcomes in such patients. Methods This was a retrospective study conducted during the period 2018-2019 at an academic institution; it included adult patients who were mechanically ventilated, requiring and awaiting admission to the ICU from the ED. Results We included a total of 388 out of 537 patients in the analysis. Patients were stratified into three groups as follows: 93 (24%) were admitted to the ICU within six hours; 126 (32.5%) were admitted to the ICU within 6-24 hours; and 169 (43.6%) were admitted to the ICU after 24 hours. Patients admitted to the ICU within six hours were significantly younger; the mean age of the patients was 55 ± 16.30 years in group 1, 61.96 ± 17.73 years in group 2, and 62.65 ± 16.62 years in group 3 (p=0.001). The ICU mortality in group 1 was lower than in other groups, and mortality increased with increasing boarding time [28 (30.1%), 51 (40.5%), 79 (46.7%), respectively, p=0.032]. Boarding time in the ED was associated with an increased risk of ICU mortality in group 3 compared with group 1 (0.1664 ± 0.063, p=0.009). The logistic regression analysis showed higher mortality rates in groups 2 [adjusted odds ratio: 3.29; 95% confidence interval (CI): 1.95-5.55, p<0.01] and 3 (adjusted odds ratio: 1.98; 95% CI: 1.17-3.35, p=0.01). Conclusion Based on our findings from this small-sample, single-center study, ED boarding of mechanically ventilated patients is associated with higher ICU mortality rates.
背景与目的 在过去几年中，急诊科（ED）危重症患者的滞留时间呈上升趋势。急诊医生现在经常遇到需要快速复苏和稳定病情的危重症患者，并在急诊科提供延长护理。本研究旨在评估急诊科机械通气患者的滞留时间与此类患者预后之间的关联。方法 这是一项于2018 - 2019年在一所学术机构进行的回顾性研究；纳入了从急诊科需要并等待入住重症监护病房（ICU）的机械通气成年患者。结果 我们在分析中纳入了537例患者中的388例。患者被分为以下三组：93例（24%）在6小时内入住ICU；126例（32.5%）在6 - 24小时内入住ICU；169例（43.6%）在24小时后入住ICU。6小时内入住ICU的患者明显更年轻；第1组患者的平均年龄为55±16.30岁，第2组为61.96±17.73岁，第3组为62.65±16.62岁（p = 0.001）。第1组的ICU死亡率低于其他组，且死亡率随着滞留时间的增加而升高[分别为28例（30.1%）、51例（40.5%）、79例（46.7%），p = 0.032]。与第1组相比，第3组在急诊科的滞留时间与ICU死亡率增加的风险相关（0.1664±0.063，p = 0.009）。逻辑回归分析显示第2组[调整后的优势比：3.29；95%置信区间（CI）：1.95 - 5.
