肺動脈カテーテル化頻度に影響を与える患者の特徴とICUの組織要因
J Rapoport1, D Teres, J Steingrub
1Mount Holyoke College, 50 College St, South Hadley, MA 01075, USA. rapoport@mtholyoke.edu
JAMA
|May 18, 2000
まとめ
肺動脈カテーテルの使用は,ICUの組織,医師のスタッフ,患者の保険,人種によって大きく異なります. フルタイムICUの医師は,カテーテルの使用が減少し,外科ICUや民間保険の利用が増加した.
科学分野:
- クリティカルケア・メディシン
- 医療サービス 研究 医療サービス
- 医療機器の利用 医療機器の利用
背景:
- 肺動脈カテーテル (PAC) の血液動力学的モニタリングでの使用は,有効性のデータが限られているため,議論されています.
- 集中治療室 (ICU) の組織と患者の特徴を含むPACの利用に影響を与える要因は不明である.
研究 の 目的:
- PACの使用とICUの組織的要因との関係を調査する.
- PAC利用と関連して,病気の重症度や保険状態などの患者の特徴を調査する.
主な方法:
- 27の病院の34のICUで10217人の非手術患者を含む遡及的データベース研究.
- 簡略化された急性生理学スコア (SAPS),蘇生状態,ICUのタイプ,サイズ,モデルに基づくPAC使用の分析.
主要な成果:
- PACは患者の8.1%で使用された.
- フルタイムICUの医師は,PACの確率を67% (OR,0.36) 減少させた.
- 高いPAC使用率は,白人 (OR, 1.38) と民間保険 (OR, 1.33) と関連していた. 外科ICUは,医療ICUと比較して,PACの使用量の2倍 (OR, 2.17) を示しました.
結論:
- ICUの組織的要因,保険,人種,および臨床的変数は,PACの実践パターンに影響を与えます.
- 臨床的および経済的結果に関するさらなる研究が必要である.
- これらの影響を理解することで,合理的なPAC使用のための政策を導くことができます.
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