Improvement in intensive care unit outcomes in patients with subarachnoid hemorrhage after initiation of neurointensivist co-management
Improvement in intensive care unit outcomes in patients with subarachnoid hemorrhage after initiation of neurointensivist co-management
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DOI：
10.3171/2009.8.jns09441
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发表时间：
2010-03-01
影响因子：
4.1
通讯作者：
Ko, Nerissa U.
中科院分区：
文献类型：
--
作者：
Josephson, S. Andrew;Douglas, Vanja C.;Ko, Nerissa U.
Object.神经重症监护医师是经过培训的专家，负责管理神经病患者重症监护病房（ICU）的各个方面。迄今为止，还没有研究专门研究神经重症监护医师在蛛网膜下腔出血（SAH）管理中的作用。本研究探讨了基于团队的神经重症监护医师共同管理方法的使用。作者回顾了所有病例，涉及在超过4年的时间内进入神经外科服务的SAH患者。对强制性神经重症监护医师共同管理策略开始之前和之后收治的患者进行比较。研究的主要结果是ICU停留时间。次要结局包括住院死亡率、脑室腹腔分流术放置和其他并发症，如发热、抗生素使用、加压剂使用和呼吸机相关性肺炎。共纳入512名患者，其中216名在开始神经重症监护医师联合管理之前，296名在开始神经重症监护医师联合管理之后。在开始神经重症监护医师联合管理后，ICU住院时间显著缩短（平均12.4 vs 10.9天，p = 0.02），即使在调整人口统计学特征和入院Hunt和Hess分级后。开始共同管理方法后，需要进行脑室腹腔分流的患者百分比显着下降（23.0% vs 11.5%，p = 0.001），但院内死亡率没有受到影响。结论。神经重症监护医师的常规参与策略的启动，负责管理患者护理的各个方面，导致神经外科SAH患者的ICU停留时间显著缩短。这种以团队为基础的方法，使用神经重症监护医师来管理神经外科SAH患者，值得进一步研究作为一种成功的护理模式。(DOI：10.3171/2009.8.JNS09441）
Object. Neurointensivists are specialists trained to manage all aspects of the intensive care unit (ICU) stay of neurologically ill patients. No study to date has examined the role of neurointensivists specifically in subarachnoid hemorrhage (SAH) management. This study examined the use of a team-based neurointensivist co-management approach.Methods. The authors reviewed all cases involving patients with SAH admitted to the neurosurgical service during a period of more than 4 years. A comparison was made between those patients admitted before and those admitted after the initiation of a mandatory neurointensivist co-management strategy. The primary outcome examined was length of ICU stay. Secondary outcomes included in-hospital mortality, ventriculoperitoneal shunt placement, and other complications such as fever, antibiotic use, pressor utilization, and ventilator-associated pneumonia.Results. A total of 512 patients were included, 216 prior to and 296 after the initiation of neurointensivist co-management. Length of ICU stay was significantly decreased after the initiation of neurointensivist co-management ( mean 12.4 vs 10.9 days, p = 0.02), even after adjusting for demographic characteristics and admission Hunt and Hess grade. The percentage of patients requiring a ventriculoperitoneal shunt significantly decreased after initiation of the co-management approach (23.0 vs 11.5%, p = 0.001), but in-house mortality was unaffected.Conclusions. Initiation of a strategy of routine involvement of a neurointensivist, charged with managing all aspects of the patients' care, resulted in a significantly reduced length of ICU stay for neurosurgical SAH patients. This team-based approach, using neurointensivists to manage neurosurgical SAH patients, merits further study as a successful model of care. (DOI: 10.3171/2009.8.JNS09441)