Intensive Care Unit Capacity Strain and Outcomes of Critical Illness in a Resource-Limited Setting: A 2-Hospital Study in South Africa
Intensive Care Unit Capacity Strain and Outcomes of Critical Illness in a Resource-Limited Setting: A 2-Hospital Study in South Africa
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DOI：
10.1177/0885066618815804
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发表时间：
2020-10-01
影响因子：
3.1
通讯作者：
Wise, Robert D.
中科院分区：
文献类型：
--
作者：
Anesi, George L.;Gabler, Nicole B.;Wise, Robert D.
目的：在资源有限的情况下，测量重症监护室（ICU）容量紧张与护理过程和危重病结局的相关性。研究方法：我们使用南非第一个发布的多中心电子重症监护数据库，对南非2家公立医院的5332例ICU患者进行了回顾性队列研究。我们评估了在不同暴露时间点（ICU转诊、入院和/或出院）的多个ICU容量应变指标（ICU占用率、周转率、人口普查敏锐度和转诊负担）与临床和护理结果过程之间的关联。采用多变量考克斯比例风险模型分析ICU入院时ICU容量紧张与ICU住院时间（LOS）的相关性。采用线性和logistic多变量回归分析ICU分诊决策（ICU转诊时的应变）、ICU死亡率（ICU入院时的应变）和ICU LOS（ICU出院时的应变）的次要结局。结果：在ICU入院时，ICU容量应变与ICU LOS（主要结局）无关。入住ICU时ICU占用率与ICU死亡率增加相关（比值比= 1.07，95%置信区间：1.02-1.11;P= .004），这是次要结局，ICU占用率增加10%与ICU死亡率增加7%相关。结论：在南非资源有限的环境中，ICU入院时的ICU容量紧张与ICU LOS无关。在二次分析中，ICU入院时较高的ICU占用率与ICU死亡率增加相关，但其他容量紧张指标与ICU死亡率增加无关。
Objective: To measure the association of intensive care unit (ICU) capacity strain with processes of care and outcomes of critical illness in a resource-limited setting. Methods: We performed a retrospective cohort study of 5332 patients referred to the ICUs at 2 public hospitals in South Africa using the country's first published multicenter electronic critical care database. We assessed the association between multiple ICU capacity strain metrics (ICU occupancy, turnover, census acuity, and referral burden) at different exposure time points (ICU referral, admission, and/or discharge) with clinical and process of care outcomes. The association of ICU capacity strain at the time of ICU admission with ICU length of stay (LOS), the primary outcome, was analyzed with a multivariable Cox proportional hazard model. Secondary outcomes of ICU triage decision (with strain at ICU referral), ICU mortality (with strain at ICU admission), and ICU LOS (with strain at ICU discharge), were analyzed with linear and logistic multivariable regression. Results: No measure of ICU capacity strain at the time of ICU admission was associated with ICU LOS, the primary outcome. The ICU occupancy at the time of ICU admission was associated with increased odds of ICU mortality (odds ratio = 1.07, 95% confidence interval: 1.02-1.11;P= .004), a secondary outcome, such that a 10% increase in ICU occupancy would be associated with a 7% increase in the odds of ICU mortality. Conclusions: In a resource-limited setting in South Africa, ICU capacity strain at the time of ICU admission was not associated with ICU LOS. In secondary analyses, higher ICU occupancy at the time of ICU admission, but not other measures of capacity strain, was associated with increased odds of ICU mortality.