Randomized trial of automated, electronic monitoring to facilitate early detection of sepsis in the intensive care unit*.
Randomized trial of automated, electronic monitoring to facilitate early detection of sepsis in the intensive care unit*.
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DOI：
10.1097/ccm.0b013e318250a887
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发表时间：
2012-07
影响因子：
8.8
通讯作者：
Rice TW
中科院分区：
文献类型：
--
作者：
Hooper MH;Weavind L;Wheeler AP;Martin JB;Gowda SS;Semler MW;Hayes RM;Albert DW;Deane NB;Nian H;Mathe JL;Nadas A;Sztipanovits J;Miller A;Bernard GR;Rice TW
确定在内科重症监护病房（MICU）患者中，通过医生通知自动识别全身炎症反应综合征是否可加速早期给予新抗生素或改善脓毒症患者的其他患者结局。一项前瞻性、随机、对照、单中心研究。一个学术性的三级医疗中心的MICU。442名连续患者在4个月内入院，符合MICU中改良的SIRS标准。患者被随机分配至通过电子“监听应用程序”进行监测，以检测改良（SIRS）标准与常规护理。当检测到修改的SIRS标准时，监听应用程序实时通知医生，但不提供管理建议。无论是在所有患者中进行比较，干预组还是常规治疗组的新抗生素使用时间中位数相似（6.0小时vs 6.1小时，p=0.95），脓毒症患者（5.3h vs. 5.1h; p=0.90）、入组时使用抗生素的患者（5.2 h vs. 7.0 h，p= 0.27）或入组时未使用抗生素的患者（5.2 h vs. 5.1 h，p= 0.85）。无论是比较所有患者还是仅比较入组时出现水肿的患者，在检测到改良的SIRS标准后，两组之间给予的液体量相似。其他临床结局，包括ICU住院时间、住院时间和死亡率，在干预组和对照组患者之间没有差异。在一个三级医疗MICU中，向医生发出修改后的SIRS标准的实时警报是可行和安全的，但不会影响脓毒症的治疗干预措施或显著改变临床结局。
To determine whether automated identification with physician notification of the systemic inflammatory response syndrome in medical intensive care unit (MICU) patients expedites early administration of new antibiotics or improvement of other patient outcomes in patients with sepsis. A prospective, randomized, controlled, single-center study. MICU of an academic, tertiary-care medical center. 442 consecutive patients admitted over a 4 month period who met modified SIRS criteria in a MICU. Patients were randomized to monitoring by an electronic “Listening Application” to detect modified (SIRS) criteria vs. usual care. The Listening Application notified physicians in real-time when modified SIRS criteria were detected, but did not provide management recommendations. The median time to new antibiotics was similar between the intervention and usual care groups whether comparing among all patients (6.0h vs 6.1h, p=0.95), patients with sepsis (5.3h vs. 5.1h; p=0.90), patients on antibiotics at enrollment (5.2h vs. 7.0h, p= 0.27), or patients not on antibiotics at enrollment (5.2h vs. 5.1h, p= 0.85). The amount of fluid administered following detection of modified SIRS criteria was similar between groups whether comparing all patients or only patients hypotensive at enrollment. Other clinical outcomes including ICU length of stay, hospital length of stay, and mortality were not shown to be different between patients in the intervention and control groups. Real-time alerts of modified SIRS criteria to physicians in one tertiary care MICU were feasible and safe but did not influence measured therapeutic interventions for sepsis or significantly alter clinical outcomes.