Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study.
Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study.
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DOI：
10.1186/cc9975
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Bonametti AM
中科院分区：
文献类型：
--
作者：
Cardoso LT;Grion CM;Matsuo T;Anami EH;Kauss IA;Seko L;Bonametti AM
当需要重症监护的患者数量大于可用的床位数量时，重症监护病房（ICU）的进入流量受到阻碍。这一现象与尽管有需要但没有住院的患者以及住院但正在等待床位的患者的死亡率较高有关。本研究的目的是评估ICU住院延迟是否会影响危重患者的死亡率。对2005年1月至12月在我院ICU住院的成年患者进行前瞻性队列分析。有床位的病人立即入院；当没有床位时，患者等待ICU入院。ICU入院分为延迟或立即入院。检查的混杂变量包括：年龄、性别、原住院病房、ICU诊断、合并症、急性生理和慢性健康评估（APACHE） II评分、治疗干预和序贯器官衰竭评估（SOFA）评分。所有患者均随访至出院。共评估401例患者；即刻入院125例（31.2%），延迟入院276例（68.8%）。延迟入住ICU的患者死亡率显著增加（P = 0.002）。ICU延误导致的死亡风险比例为30%（95%可信区间（CI）： 11.2%至44.8%）。每一小时的等待与ICU死亡风险增加1.5%独立相关(风险比（HR）： 1.015；95% CI 1.006 ~ 1.023；P = 0.001)。入院时间与生存率之间存在显著关联。早期入住ICU更有可能产生积极的结果。
When the number of patients who require intensive care is greater than the number of beds available, intensive care unit (ICU) entry flow is obstructed. This phenomenon has been associated with higher mortality rates in patients that are not admitted despite their need, and in patients that are admitted but are waiting for a bed. The purpose of this study is to evaluate if a delay in ICU admission affects mortality for critically ill patients. A prospective cohort of adult patients admitted to the ICU of our institution between January and December 2005 were analyzed. Patients for whom a bed was available were immediately admitted; when no bed was available, patients waited for ICU admission. ICU admission was classified as either delayed or immediate. Confounding variables examined were: age, sex, originating hospital ward, ICU diagnosis, co-morbidity, Acute Physiology and Chronic Health Evaluation (APACHE) II score, therapeutic intervention, and Sequential Organ Failure Assessment (SOFA) score. All patients were followed until hospital discharge. A total of 401 patients were evaluated; 125 (31.2%) patients were immediately admitted and 276 (68.8%) patients had delayed admission. There was a significant increase in ICU mortality rates with a delay in ICU admission (P = 0.002). The fraction of mortality risk attributable to ICU delay was 30% (95% confidence interval (CI): 11.2% to 44.8%). Each hour of waiting was independently associated with a 1.5% increased risk of ICU death (hazard ratio (HR): 1.015; 95% CI 1.006 to 1.023; P = 0.001). There is a significant association between time to admission and survival rates. Early admission to the ICU is more likely to produce positive outcomes.
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