Is the volume of mechanically ventilated admissions to UK critical care units associated with improved outcomes?
Is the volume of mechanically ventilated admissions to UK critical care units associated with improved outcomes?
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DOI：
10.1007/s00134-013-3205-4
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发表时间：
2014-03-01
影响因子：
38.9
通讯作者：
Rowan, K. M.
中科院分区：
文献类型：
--
作者：
Shahin, Jason;Harrison, D. A.;Rowan, K. M.
目前尚不清楚英国重症监护室机械通气入院患者的容量与结局是否存在关系。本研究旨在评估英国成人普通重症监护病房机械通气患者的容量-结果关系，以期为政策、服务提供和专家高级呼吸护理组织提供信息。关注的主要暴露是每年每个重症监护病房机械通气入院的年数量（绝对数量）。主要结局为最终急性住院死亡率。进行多变量分析，以评估年交易量和结果之间的关系，同时调整先验选择的混杂因素。进行了两次交互测试。第一个相互作用检验是年通气量和入院类型之间的相互作用检验，第二个是年通气量和初始急性呼吸衰竭严重程度之间的相互作用检验。还进行了排除体积离群值单位并使用限制性三次样条来建模体积的敏感性分析。调整混杂因素后，年体积与最终急性住院死亡率之间存在显着关系（p < 0.02）。第一次交互作用检验显示，年住院量和住院类型之间存在强交互作用，非手术住院量与结果的关系更为明显（p < 0.001）。年通气量与初始急性呼吸衰竭严重程度之间的第二次相互作用检验无统计学显著性（p = 0.12）。使用限制性三次样条的分析显示了类似的图形关系，但结果无统计学意义（p = 0.87）。在英国，成人普通重症监护室的机械通气入院患者显示了容量-结局关系。这种关系对所使用的建模方法很敏感。
It is unknown whether a volume-outcome relationship exists for mechanically ventilated admissions to UK critical care units. This study was conducted to evaluate the volume-outcome relationship for mechanically ventilated admissions to adult, general critical care units in the UK with a view to informing policy, service delivery and organisation of specialist, advanced respiratory care.A retrospective cohort study using data from the Case Mix Programme Database was conducted. The primary exposure of interest was annual volume (absolute number) of mechanically ventilated admissions per critical care unit per year. The primary outcome was ultimate acute hospital mortality. A multivariable analysis was performed to assess the relationship between annual volume and outcome while adjusting for a priori selected confounders. Two interaction tests were performed. The first interaction test was between annual volume and admission type and the second between annual volume and initial acute severity of respiratory failure. Sensitivity analysis excluding volume outlier units and using restricted cubic splines to model volume was also performed.After adjusting for confounding, there was a significant relationship between annual volume and ultimate acute hospital mortality (p < 0.02). The first interaction test revealed a strong interaction between annual volume and admission type, with a more pronounced volume-outcome relationship for non-surgical admissions (p < 0.001). The second interaction test between annual volume and initial acute severity of respiratory failure was not statistically significant (p = 0.12). The analysis using restricted cubic splines demonstrated a similar graphical relationship but the results were not statistically significant (p = 0.87).A volume-outcome relationship was demonstrated for mechanically ventilated admissions to adult, general critical care units in the UK. The relationship is sensitive to the modelling approach used.