Xu Junma, Xie Yi, Yuan Dong, Shao Chan, Xu Fangqin, Han Shu
Department of Geriatrics, Jintan First People's Hospital of Changzhou, Changzhou 210039, Jiangsu, China.
Department of Critical Care Medicine, Jintan First People's Hospital of Changzhou City, Changzhou 210039, Jiangsu, China. Corresponding author: Xu Junma, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Aug;36(8):867-870. doi: 10.3760/cma.j.cn121430-20240109-00024.
To explore the feasibility and safety of integrating the geriatric intensive care unit (GICU) into the friendly management model of the elderly critically ill patients.
A prospective controlled study was conducted. Patients with elderly critically ill admitted to the GICU and the general intensive care unit (ICU) of Jintan First People's Hospital of Changzhou from December 2021 to May 2023 were enrolled. Patients in the ICU group received the traditional intensive care and nursing mode. In addition to the ICU group basic medical care measures, the patients in the GICU group were treated with friendly management models such as flexible visitation, diagnosis and treatment environment optimization, caring diagnosis and treatment, and family participation in hospice care according to their condition assessment. The gender, age, main diagnosis, and acute physiology and chronic health evaluation II (APACHE II) at admission were recorded and compared between the two groups. During the treatment period, the incidence of nosocomial infection, unplanned extubation, falling out of bed/fall, unexpected readmission to ICU/GICU, and ICU/GICU mortality, the incidence of post-intensive care syndrome (PICS), the satisfaction rate of patients/families with medical care, and the satisfaction rate of patients/families with diagnosis and treatment environment were recorded and compared between the two groups.
According to the admission criteria for ICU and GICU, as well as the willingness of the patients and/or their families, a total of 59 patients were finally included in the ICU group, and 48 patients were enrolled in the GICU group. There were no significantly differences in gender, age, main diagnosis and APACHE II score between the two groups, and there were comparability. There were no significantly differences in the incidence of adverse events such as nosocomial infection [13.6% (8/59) vs. 12.5% (6/48)], unplanned extubation [5.1% (3/59) vs. 6.2% (3/48)], falling out of bed/fall [3.4% (2/59) vs. 0% (0/48)], unexpected readmission to ICU/GICU [8.5% (5/59) vs. 10.4% (5/48)], and ICU/GICU mortality [6.8% (4/59) vs. 6.2 (3/48)] between the ICU group and GICU group (all P > 0.05). Compared with the ICU group, the incidence of PICS in GICU group was significantly lower [8.3% (4/48) vs. 25.4% (15/59), P < 0.05], the satisfaction rate of patients/families with medical care [89.6% (43/48) vs. 74.6% (44/59)] and satisfaction rate of patients/families with diagnosis and treatment environment [87.5% (42/48) vs. 67.8% (40/59)] were significantly increased (both P < 0.05).
The use GICU as a friendly management model for elderly critically ill patients is feasible and safe, and it is worthy of further exploration and research.
探讨将老年重症监护病房（GICU）融入老年危重症患者友好管理模式的可行性与安全性。
进行一项前瞻性对照研究。纳入2021年12月至2023年5月期间在常州市金坛区第一人民医院GICU及综合重症监护病房（ICU）收治的老年危重症患者。ICU组患者接受传统的重症监护及护理模式。GICU组患者除接受ICU组的基本医疗护理措施外，根据病情评估采用灵活探视、优化诊疗环境、关怀诊疗、家属参与临终关怀等友好管理模式进行治疗。记录并比较两组患者的性别、年龄、主要诊断、入院时急性生理学与慢性健康状况评分系统II（APACHE II）。治疗期间，记录并比较两组患者的医院感染发生率、非计划拔管率、坠床/跌倒发生率、意外重返ICU/GICU率、ICU/GICU死亡率、重症监护后综合征（PICS）发生率、患者/家属对医疗护理的满意度以及患者/家属对诊疗环境的满意度。
根据ICU和GICU的收治标准以及患者和/或其家属的意愿，最终ICU组纳入59例患者，GICU组纳入48例患者。两组患者在性别、年龄、主要诊断及APACHE II评分方面差异无统计学意义，具有可比性。两组患者在医院感染[13.6%（8/59）比12.5%（6/48）]、非计划拔管[5.1%（3/59）比6.2%（3/48）]、坠床/跌倒[3.4%（2/59）比0%（0/48）]、意外重返ICU/GICU[8.5%（5/59）比10.4%（5/48）]以及ICU/GICU死亡率[6.8%（4/59）比6.2%（3/48）]等不良事件发生率方面差异均无统计学意义（均P>0.05）。与ICU组相比，GICU组PICS发生率显著降低[8.3%（4/48）比25.4%（15/59），P<0.05]，患者/家属对医疗护理的满意度[89.6%（43/48）比74.6%（44/59）]及患者/家属对诊疗环境的满意度[87.5%（42/48）比67.8%（40/59）]均显著提高（均P<0.05）。
将GICU作为老年危重症患者的友好管理模式是可行且安全的，值得进一步探索研究。
