Oh Tak Kyu, Song In-Ae
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620, South Korea.
Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
Ann Intensive Care. 2023 Jan 13;13(1):4. doi: 10.1186/s13613-023-01100-5.
The difference in survival outcomes between closed and open intensive care unit (ICU) designs with respect to trained intensivist coverage remains unknown. We aimed to investigate whether trained intensivist coverage is associated with mortality in critically ill patients admitted to the ICU in South Korea.
This population-based cohort study used nationwide registration data from South Korea. This study enrolled all adult patients admitted to the ICU between January 1, 2016, and December 31, 2019. Patients, who were admitted ICU in a hospital that employed trained intensivists, were designated as the intensivist group.
This study included 1,147,493 critically ill patients admitted to the ICU. The intensivist and non-intensivist groups consisted of 484,004 (42.2%) and 663,489 (57.8%) patients, respectively. Mixed effect logistic regression revealed a 22% lower in-hospital mortality rate (odds ratio: 0.78. 95% confidence interval: 0.74, 0.81; P < 0.001) than that in the non-intensivist group. Mixed effect Cox regression revealed a 15% lower 1-year mortality rate (hazard ratio: 0.85. 95% confidence interval: 0.83, 0.89; P < 0.001) in the intensivist group than that in the non-intensivist group. Moreover, the in-hospital mortality was significantly lower in the intensivist group than that in the non-intensivist group, irrespective of age, Charlson comorbidity index, surgery or non-surgery associated admission, and invasive treatment during ICU stay.
A closed ICU design with trained intensivist coverage was associated with lower in-hospital and 1-year mortality rates. Our results suggest that hospitals should employ trained intensivists to improve both short-term and long-term survival outcomes of critically ill patients.
关于配备受过培训的重症监护医生的封闭式和开放式重症监护病房（ICU）设计在生存结局方面的差异尚不清楚。我们旨在调查在韩国入住ICU的重症患者中，受过培训的重症监护医生配备情况是否与死亡率相关。
这项基于人群的队列研究使用了韩国的全国登记数据。本研究纳入了2016年1月1日至2019年12月31日期间入住ICU的所有成年患者。在聘用了受过培训的重症监护医生的医院入住ICU的患者被指定为重症监护医生组。
本研究包括1,147,493名入住ICU的重症患者。重症监护医生组和非重症监护医生组分别由484,004名（42.2%）和663,489名（57.8%）患者组成。混合效应逻辑回归显示，与非重症监护医生组相比，住院死亡率低22%（优势比：0.78，95%置信区间：0.74，0.81；P < 0.001）。混合效应Cox回归显示，重症监护医生组的1年死亡率比非重症监护医生组低15%（风险比：0.85，95%置信区间：0.83，0.89；P < 0.001）。此外，无论年龄、查尔森合并症指数、手术或非手术相关入院情况以及ICU住院期间的侵入性治疗如何，重症监护医生组的住院死亡率均显著低于非重症监护医生组。
配备受过培训的重症监护医生的封闭式ICU设计与较低的住院死亡率和1年死亡率相关。我们的结果表明，医院应聘用受过培训的重症监护医生，以改善重症患者的短期和长期生存结局。
