Arikan Hüseyin, Yeler Ayvaz, Esen Ramazan
Unit of Internal Medicine Intensive Care, Van Yüzüncü Yıl University, Dursun Odabaş Medical Center, Van, Türkiye.
Department of Internal Medicine, Van Yüzüncü Yıl University Faculty of Medicine, Van, Türkiye.
Tuberk Toraks. 2024 Jun;72(2):145-151. doi: 10.5578/tt.202402940.
Intensivists play a critical role in the management of intensive care units (ICUs) and in providing high quality care. While international guidelines recommend intensivist staffing for improved patient outcomes, there is a shortage of qualified intensivists in many regions, including Türkiye. This study aimed to assess the impact of introducing a full-time intensivist to a medical ICU on patient characteristics, outcomes, and ICU interventions.
This retrospective study analyzed data from the Internal Medicine ICU at Van Yüzüncü Yıl University Dursun Odabaş Medical Center over two periods: Pre- and post-intensivist recruitment. The study included adult patients admitted to the ICU from February 2018 to January 2020. Patient demographics, reasons for ICU admission, APACHE-II and SOFA scores, ICU interventions, and outcomes were recorded and compared between the two periods.
Of the 868 patients admitted during the study period, 820 were included in the analysis. There were no significant differences in demographic characteristics between the pre- and post-intensivist periods. However, patients in the post-intensivist period had higher APACHE-II and SOFA scores. Intensive care units mortality rates were comparable between the two periods. The post-intensivist period saw increased use of invasive mechanical ventilation and non-invasive ventilation compared to the pre-intensivist period. Renal replacement therapy usage and enteral nutrition provision also increased in the post-intensivist period. ICU and hospital lengths of stay remained similar between the two periods.
The introduction of a full-time intensivist to the medical ICU led to changes in ICU interventions, including increased use of mechanical ventilation and renal replacement therapy. Despite these changes, ICU mortality rates remained unchanged. Further research is needed to explore the longterm impact of intensivist staffing on patient outcomes in Türkiye.
重症医学专家在重症监护病房（ICU）的管理以及提供高质量护理方面发挥着关键作用。虽然国际指南推荐配备重症医学专家以改善患者预后，但包括土耳其在内的许多地区都缺乏合格的重症医学专家。本研究旨在评估在医疗ICU引入全职重症医学专家对患者特征、预后及ICU干预措施的影响。
这项回顾性研究分析了凡于祖尔居勒大学杜尔孙·奥达巴什医学中心内科ICU两个时期的数据：重症医学专家招聘前和招聘后。该研究纳入了2018年2月至2020年1月入住ICU的成年患者。记录并比较了两个时期患者的人口统计学资料、ICU入院原因、急性生理与慢性健康状况评分系统（APACHE-II）和序贯器官衰竭评估（SOFA）评分、ICU干预措施及预后。
在研究期间收治的868例患者中，820例纳入分析。重症医学专家招聘前后的人口统计学特征无显著差异。然而，重症医学专家招聘后的患者APACHE-II和SOFA评分更高。两个时期的ICU死亡率相当。与重症医学专家招聘前相比，招聘后有创机械通气和无创通气的使用增加。重症医学专家招聘后肾脏替代治疗的使用和肠内营养的提供也有所增加。两个时期的ICU住院时间和住院时间相似。
在医疗ICU引入全职重症医学专家导致了ICU干预措施的改变，包括机械通气和肾脏替代治疗的使用增加。尽管有这些变化，但ICU死亡率保持不变。需要进一步研究以探讨重症医学专家配备对土耳其患者预后的长期影响。
