英国重症监护室持续性重症的时间和负担:一项观察性队列研究
David A Harrison1, Ben C Creagh-Brown2,3, Kathryn M Rowan1
1Intensive Care National Audit & Research Centre (ICNARC), London, UK.
Journal of the Intensive Care Society
|June 1, 2023
概括
慢性因素预测在重症监护室 (ICU) 住院11天后,持续性严重疾病的生存率. 这一发现影响了对重症患者的长期结果和医疗保健资源使用的理解.
科学领域:
- 关键护理医学 关键护理医学
- 临床流行病学临床流行病学
- 医疗服务研究 医疗服务研究
背景情况:
- 持续性重症 (PCI) 是一种综合症,持续性重症,而不是入院的最初原因,决定了重症监护室 (ICU) 的停留.
- 了解慢性患者因素在预测存活率时超过急性因素的过渡点对于管理PCI至关重要.
- PCI与显著的医疗保健利用率和不良患者结果有关.
研究的目的:
- 为了确定慢性患者的生存因素 (年龄,性别,并发症) 变得比急性入院因素更有预测性,确定ICU的一天.
- 评估这种预测性转变在患者子组和随着时间的推移中的一致性.
- 为了比较持久性严重疾病患者与其他ICU患者的特征和结果.
主要方法:
- 一项观察性队列研究分析了来自英格兰,威尔士和北爱尔兰217个ICU的835,946名成年患者的数据 (2009年4月至2016年3月).
- 统计模型 ("慢性"和"急性") 根据在ICU停留的时间长达28天,每天调整和更新.
- 主要结局指标是医院出院时的死亡率.
主要成果:
- 在ICU第11天",慢性"模型的预测能力超过了"急性"模型.
- 患有长时间ICU住院 (>10天) 的患者,占入院人数的9%,消耗了ICU睡眠时间的45%.
- 整体死亡率为30%,平均在ICU停留22天和另外28天住院后.
结论:
- 慢性因素在ICU入院的第11天左右成为持续性严重疾病的生存的主要预测因素.
- 这凸显了需要改进预后工具和了解长期严重疾病患者的长期结果的需要.
- 解决PCI对于人道的患者护理和优化医疗保健经济资源至关重要.
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