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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Mortality among patients managed by a nurse practitioner or physicians in a medical-surgical intensive care unit: A
Daichi Watanabe1, Takashi Kimura2, Shinya Yamaguchi3
1Department of Public Health, Graduate School of Medicine, Hokkaido University, Japan; Department of Nursing, Anaesthesiology and Intensive Care, Teine Keijinkai Hospital, Japan.
Introduction:
Nurse practitioners are being increasingly integrated into critical care teams. In Western countries, nurse practitioner (NP)-led care yields clinical outcomes comparable to physician-led care. However, no study in Asia has compared intensive care unit (ICU) mortality rates between patients managed by NPs and those managed by physicians.
Objectives:
The aim of this study was to compare mortality rates between patients managed by an NP and those managed by physicians, both under the supervision of attending intensivists and to evaluate the potential impact of this care model on patient outcomes.
Methods:
This retrospective cohort study included patients aged 18 years or older who were admitted to the ICU between April 1, 2023, and March 31, 2024. Those managed by a single NP were classified into the NP group, and those managed by intensivists or residents were classified into the physician group. Due to potentially nonrandom allocation of patients, a weighted analysis based on propensity scores was applied. ICU mortality, ventilator days, and ICU length of stay were compared between the groups using weighted analyses.
Results:
Among the 975 eligible patients, 109 and 866 were assigned to the NP and physician groups, respectively. Weighted analyses estimated the ICU mortality rate was 6.1% in the NP group and 7.2% in the physician group (risk difference: -0.01; 95% confidence interval [CI]: -0.06 to 0.03; risk ratio: 0.84; 95% CI: 0.39 to 1.83), the mean number of ventilator days was 1.6 in both groups (mean difference: 0.001; 95% CI: -1.09 to 1.09), and the mean ICU length of stay was 4.8 days in the NP group and 3.9 days in the physician group (mean difference: 0.91; 95% CI: -0.40 to 2.29).
Conclusions:
Our findings suggest that outcomes in the NP group were similar to those in the physician group. This specific model of NP-led care, delivered under supervision of attending intensivists, may be a feasible option to manage critically ill patients. However, this study was conducted in a single centre involving a single NP, and the wide CIs warrant cautious interpretation regarding the precision of the estimates.
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