大规模医疗疏散以减轻重症监护负担:来自COVID-19患者大规模转移的结果 (TRANSCOV) 队列研究
Olivier Grimaud1, Emmanuelle Leray1, Sahar Bayat1
1Univ Rennes, EHESP, CNRS, ARENES - UMR 6051, Rennes, France.
Chest
|September 12, 2025
概括
在COVID-19大流行期间,重症监护室 (ICU) 患者的大规模转移显著降低了病例死亡率. 这种生存益处很可能是由于患者的选择和过度拥挤的重症监护室的工作量减少.
科学领域:
- 临界护理医学 临界护理医学
- 流行病学 流行病学
- 公共卫生 公共卫生
背景情况:
- 在COVID-19流行病的第一波期间,法国实施了重症监护室 (ICU) 患者的大规模转移.
- 早期报告表明,转移患者的病例死亡率降低了3至4倍.
- 除了患者选择之外,这种改善生存的原因尚不清楚.
研究的目的:
- 为了确定28天ICU病例死亡率是否在转移和匹配的对照 (未转移) 患者之间有所不同.
- 调查在质量转移场景中导致生存差异的因素.
主要方法:
- 一个多中心的回顾性队列研究,涉及285名转移和667名控制ICU患者.
- 患者被同时接收到同一个ICU,并且在转移后5天活着.
- 28天ICU病例死亡率和ICU住院期间的临床事件的比较.
主要成果:
- 转移患者的死亡率降低了7倍 (调整后的发病率比率为0.14).
- 虽然在入院时更健康 (更轻松,更自主),但转移的患者在ICU停留时间更长, Delirium/精神障碍更多.
- 对照患者的急性损伤率更高.
结论:
- 患者选择有助于更好的生存率,但从过度拥挤的重症监护室移除也起到了重要作用.
- 大量转移可以通过减少工作量来改善生存率,这可能有利于转移和剩余的患者.
- 早期组织大规模转移可以成为管理压倒性的ICU需求的策略.
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