Jeon Kyeongman, Kim Jin Hyoung, Kim Kyung Chan, Lee Heung Bum, Lee Hongyeul, Lee Song I, Huh Jin-Won, Kwack Won Gun, Chang Youjin, Kang Yun-Seong, Lee Won Yeon, Kim Je Hyeong
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Acute Crit Care. 2025 May;40(2):209-220. doi: 10.4266/acc.004128. Epub 2025 May 22.
Sepsis is a leading cause of intensive care unit (ICU) admission. However, few studies have evaluated how the ICU model affects the outcomes of patients with sepsis.
This post hoc analysis of data from the Management of Severe Sepsis in Asia's Intensive Care Units II study included 537 patients with sepsis admitted to 27 ICUs in Korea. The outcome measures of interest were compared between the closed ICU group, patients admitted under the full responsibility of an intensivist as the primary attending physician, and the open ICU group. The association between a closed ICU and ICU mortality was evaluated using a logistic regression analysis.
Altogether, 363 and 174 enrolled patients were treated in open and closed ICUs, respectively. Compliance with the sepsis bundles did not differ between the two groups; however, the closed ICU group had a higher rate of renal replacement therapy and shorter duration of ventilator support. The closed ICU group also had a lower ICU mortality rate than the open ICU group (24.7% vs. 33.1%). In a logistic regression analysis, management in the closed ICU was significantly associated with a decreased ICU mortality rate even after adjusting for potential confounding factors (adjusted odds ratio, 0.576; 95% CI, 0.342-0.970), and that association was observed for up to 90 days.
Sepsis management in closed ICUs was significantly associated with improved ICU survival and decreased length of ICU stay, even though the compliance rates for the sepsis bundles did not differ between open and closed ICUs.
脓毒症是重症监护病房（ICU）收治患者的主要原因。然而，很少有研究评估ICU模式如何影响脓毒症患者的预后。
这项对亚洲重症监护病房严重脓毒症管理II研究数据的事后分析纳入了韩国27个ICU收治的537例脓毒症患者。比较了封闭式ICU组（由重症医学专家作为主要主治医生全权负责收治的患者）和开放式ICU组之间感兴趣的结局指标。使用逻辑回归分析评估封闭式ICU与ICU死亡率之间的关联。
总共363例和174例入组患者分别在开放式和封闭式ICU接受治疗。两组之间脓毒症集束化治疗的依从性无差异；然而，封闭式ICU组的肾脏替代治疗率更高，机械通气支持时间更短。封闭式ICU组的ICU死亡率也低于开放式ICU组（24.7%对33.1%）。在逻辑回归分析中，即使在调整潜在混杂因素后，封闭式ICU管理仍与ICU死亡率降低显著相关（调整后的比值比为0.576；95%置信区间为0.342 - 0.970），并且这种关联在长达90天内都存在。
尽管开放式和封闭式ICU之间脓毒症集束化治疗的依从率没有差异，但封闭式ICU中的脓毒症管理与改善ICU生存率和缩短ICU住院时间显著相关。
