科罗拉多州的医院充满了COVID-19 ICU患者的死亡风险增加了吗? 一个回顾性队列研究
David R Johnson1, Debashis Ghosh2, Brandie D Wagner2
1Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA davejohnson408@u.boisestate.edu.
BMJ open
|May 9, 2024
概括
在三角洲变种激增期间,医院过度拥挤增加了COVID-19重症监护室 (ICU) 患者死亡率. 高压力,以ICU床位占用,呼吸机使用和急诊室 (ED) 溢出来衡量,与更糟糕的生存结果相关.
科学领域:
- 关键护理医学 关键护理医学
- 流行病学 流行病学
- 医疗服务研究 医疗服务研究
背景情况:
- 由于COVID-19大流行,医院资源,特别是重症监护室 (ICU) 承受了前所未有的压力.
- 了解医院压力对患者结果的影响对于在公共卫生危机期间有效管理资源至关重要.
研究的目的:
- 调查医院压力水平与重症监护室 (ICU) 的COVID-19患者存活率之间的联系.
- 分析跨不同SARS-CoV-2变种时代 (前-Delta,Delta和Omicron) 的这些关联.
主要方法:
- 在2020年8月至2022年3月期间,科罗拉多州ICU接受治疗的9196名非儿科SARS-CoV-2患者的回顾性队列研究.
- 使用通用估计方程的离散时间生存模型被采用.
- 医院压力是通过ICU床位占用,呼吸机使用和急诊室 (ED) 溢出来量化.
主要成果:
- 在三角洲变种时代,COVID-19ICU患者暴露在高ICU占用率 (第75百分位或以上) 中,与没有这种暴露的人相比,死亡几率增加了26%.
- 增加的死亡风险与高通风器利用率和ED溢出在三角洲和Omicron时代显著相关.
- 相比之下,在德尔塔前的患者表现出类似的医院充满暴露的无效甚至保护作用.
结论:
- 增加的医院压力,特别是在三角洲变种激增期间,与科罗拉多州COVID-19重症监护室患者的较高死亡率有关.
- 研究结果强调了医院容量和资源紧张对流行病期间患者生存的关键影响.
- 在前三角洲时代的对比结果表明,随着系统压力,患者和疾病因素不断演变.
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