Predicting mortality in intensive care unit patients infected with Klebsiella pneumoniae: A retrospective cohort study

IntroductionAlthough several models to predict intensive care unit (ICU) mortality are available, their performance decreases in certain subpopulations because specific factors are not included. Moreover, these models often involve complex techniques and are not applicable in low-resource settings. We developed a prediction model and simplified risk score to predict 14-day mortality in ICU patients infected with Klebsiella pneumoniae.MethodologyA retrospective cohort study was conducted using data of ICU patients infected with Klebsiella pneumoniae at the largest tertiary hospital in Northern Vietnam during 2016–2018. Logistic regression was used to develop our prediction model. Model performance was assessed by calibration (area under the receiver operating characteristic curve-AUC) and discrimination (Hosmer-Lemeshow goodness-of-fit test). A simplified risk score was also constructed.ResultsTwo hundred forty-nine patients were included, with an overall 14-day mortality of 28.9%. The final prediction model comprised six predictors: age, referral route, SOFA score, central venous catheter, intracerebral haemorrhage surgery and absence of adjunctive therapy. The model showed high predictive accuracy (AUC = 0.83; p-value Hosmer-Lemeshow test = 0.92). The risk score has a range of 0–12 corresponding to mortality risk 0–100%, which produced similar predictive performance as the original model.ConclusionsThe developed prediction model and risk score provide an objective quantitative estimation of individual 14-day mortality in ICU patients infected with Klebsiella pneumoniae. The tool is highly applicable in practice to help facilitate patient stratification and management, evaluation of further interventions and allocation of resources and care, especially in low-resource settings where electronic systems to support complex models are missing.     

The impact of the addition of nurse practitioners to surgical intensive care units: A retrospective cohort study

BackgroundDemand for surgical critical care is increasing, but work-hour restrictions on residents have affected many hospitals. Recently, the use of nurse practitioners (NPs) as providers in the intensive care unit (ICU) has expanded rapidly, although the impacts on quality of care have not been evaluated.ObjectivesTo compare the outcomes of critically ill surgical patients before and after the addition of NPs to the ICU team.MethodsWe conducted a retrospective cohort study in a Taiwanese surgical ICU. We compared the outcomes of patients admitted to ICU during the 2-year period before and after the addition of NPs to the ICU team. Patients admitted in the 1-year transition phase were excluded from comparisons. The primary endpoint was ICU mortality. Secondary endpoints included ICU length of stay and incidence of unplanned extubation.ResultsA total of 8747 patients were included in the study. For all eligible admissions, primary and secondary outcomes did not differ significantly between the two groups. For scheduled ICU admissions, ICU mortality was significantly lower after the addition of NPs (2.2% before vs. 1.1% after addition of NPs, p = 0.014). For unscheduled ICU admissions, ICU mortality did not differ significantly between the two groups. In the multivariate analysis, admission after the addition of NPs was associated with significantly reduced ICU mortality (odds ratio = 0.481; 95% confidence interval = 0.263–0.865; p = 0.015) among scheduled admissions.ConclusionIncorporating NPs in the ICU team was associated with improved outcomes in scheduled admissions to surgical ICU when compared with a traditional, resident-based team.     

Risk factors for prolonged intensive care unit stays in patients after cardiac surgery with cardiopulmonary bypass: A retrospective observational study

ObjectivesPatients after cardiac surgery with cardiopulmonary bypass (CPB) require a stay in the ICU postoperatively. This study aimed to investigate the incidence of prolonged length of stay (LOS) in the ICU after cardiac surgery with CPB and identify associated risk factors.MethodsThe current investigation was an observational, retrospective study that included 395 ICU patients who underwent cardiac surgery with CPB at a tertiary hospital in Guangzhou from June 2015 to June 2017. Data were obtained from the hospital database. Binary logistic regression modeling was used to analyze risk factors for prolonged ICU LOS.ResultsOf 395 patients, 137 (34.7%) had a prolonged ICU LOS (>72.0 h), and the median ICU LOS was 50.9 h. Several variables were found associated with prolonged ICU LOS: duration of CPB, prolonged mechanical ventilation and non-invasive assisted ventilation use, PaO₂/FiO₂ ratios within 6 h after surgery, type of surgery, red blood cell infusion during surgery, postoperative atrial arrhythmia, postoperative ventricular arrhythmia (all P < 0.05).ConclusionsThese findings are clinically relevant for identifying patients with an estimated prolonged ICU LOS, enabling clinicians to facilitate earlier intervention to reduce the risk and prevent resulting delayed recovery.     

Toward less sedation in the intensive care unit: a prospective observational study

Purpose

Excessive sedation is associated with prolonged mechanical ventilation and longer intensive care unit (ICU) and hospital stays. We evaluated the feasibility of using minimal sedation in the ICU.

Methods

Prospective observational study in a university hospital 34-bed medico-surgical department of intensive care. All adult patients who stayed in the ICU for more than 12 hours over a 2-month period were included. Intensive care unit admission diagnoses, severity scores, use of sedatives and/or opiates, duration of mechanical ventilation, length of ICU stay, and 28-day mortality were recorded for each patient.

Results

Of the 335 patients (median age, 61 years) admitted during the study period, 142 (42%) received some sedation, most commonly with midazolam and propofol. Sedative agents were administered predominantly for short periods of time (only 10% of patients received sedation for >24 hours). One hundred fifty-five patients (46%) received mechanical ventilation, generating 15?240 hours of mechanical ventilation, of these, only 2993 (20%) hours were accompanied by a continuous sedative infusion. Self-extubation occurred in 6 patients, but only 1 needed reintubation.

Conclusions

In a mixed medical-surgical ICU, minimal use of continuous sedation seems feasible without apparent adverse effects.     

Length of stay and mortality due to Clostridium difficile infection acquired in the intensive care unit

Purpose

The purpose of this study was to determine the attributable intensive care unit (ICU) and hospital length of stay and mortality of ICU-acquired Clostridium difficile infection (CDI).

Materials and methods

In this retrospective cohort study of 3 tertiary and 3 community ICUs, we screened all patients admitted between April 2006 and December 2011 for ICU-acquired CDI. Using both complete and matched cohort designs and Cox proportional hazards analysis, we determined the association between CDI and ICU and hospital length of stay and mortality. Adjustment or matching variables were site, age, sex, severity of illness, and year of admission; any infection as an ICU admitting or acquired diagnosis before the diagnosis of CDI and diagnosis of CDI were time-dependent exposures.

Results

Of 15 314 patients admitted to the ICUs during the study period, 236 developed CDI in the ICU. In the complete cohort analysis, the hazard ratios (95% confidence interval) for CDI related to ICU and hospital discharge were 0.82 (0.72, 0.94) and 0.83 (0.73, 0.95), respectively (0.5 additional ICU days and 3.4 hospital days), and related to death in ICU and hospital, they were 1.00 (0.73, 1.38) and 1.19 (0.93, 1.52), respectively. In the matched analysis, the hazard ratios for CDI related to ICU and hospital discharge were 0.91 (0.81, 1.03) and 0.98 (0.85, 1.13), respectively, and related to death in ICU and hospital, they were 1.18 (0.85, 1.63) and 1.08 (0.82, 1.43), respectively.

Conclusions

C difficile infection acquired in ICU is associated with an increase in length of ICU and hospital stay but not with any difference in ICU or hospital mortality.     

Frailty is not independently associated with intensive care unit length of stay: An observational study

BackgroundFrailty is independently associated with morbidity and mortality in critically ill patients. However, the association between preadmission frailty and the degree of treatment received in the intensive care unit (ICU) remains unclear.ObjectiveTo describe patient length of stay in an ICU and the treatments provided according to the extent of patient frailty.MethodsSingle-centre retrospective cohort study of adult patients admitted to a tertiary ICU between January 2018 and December 2019. Frailty was assessed using the Clinical Frailty Scale (CFS). The primary outcome was ICU length of stay stratified by CFS score (1–8). Secondary outcomes were the proportion of patients with each CFS score treated with vasoactive agents, invasive ventilation, noninvasive ventilation, renal replacement therapy, and tracheostomy. Poisson regression and competing risks regression was used to analyse associations between ICU length of stay and potential confounders.ResultsThe study cohort comprised 2743 patients, with CFS scores known for 2272 (83%). Length of stay in the ICU increased with each increment in the CFS up to a score of 5, beyond which it decreased with higher frailty scores. After adjusting for age, illness severity, admission type, and treatment limitation, CFS scores were not independently associated with length of stay in the ICU (P = 0.31). The proportion of patients receiving specific ICU treatments peaked at different CFS scores, being highest for vasoactive agents at CFS 5 (47%), invasive ventilation CFS 3 (51%), noninvasive ventilation CFS 6 (11%), renal replacement therapy CFS 6 (8.2%), and tracheostomy CFS 5 (2.2%). Increasing frailty was associated with increased mortality and discharge to a destination other than home.ConclusionsThe extent of frailty is not independently associated with length of stay in the ICU. The proportion of patients receiving specific ICU treatments peaked at different CFS scores.     

A 6-y retrospective cohort study of family satisfaction with critical care and decision-making in an Australian intensive care unit

BackgroundPartnering with patients and families to make decisions about care needs is a safety and quality standard in Australian health services that is often not assessed systematically.ObjectiveThe objective of this study was to retrospectively evaluate satisfaction with care and involvement in decision-making among family members of patients admitted to the intensive care unit (ICU).MethodsA retrospective cohort analysis of a satisfaction survey administered to family members of patients admitted to an ICU in an Australian metropolitan tertiary care hospital from 2014 to 2019 was conducted. The Family Satisfaction in the Intensive Care Unit questionnaire (FSICU) questionnaire was used to assess overall satisfaction, satisfaction with care, and satisfaction with decision-making on a scale from “poor” (0) to “excellent” (100).ResultsIn total, 1322 family members fully completed the survey. Respondents were typically direct relatives of ICU patients (94.2%) with an average age of 52.6 years. Most patients had an ICU length of stay <7 d (56.8%), with most patients being discharged to the ward (96.8%). The overall mean satisfaction score was high among respondents (90.26%). Similarly, mean satisfaction with care (93.06%) and decision-making (89.71%) scores were high. Satisfaction with decision-making scores remained lower than satisfaction with care scores. Multivariable modeling indicated that those younger than 50 years reported higher satisfaction scores (p = 0.006) and those with prolonged lengths of stay in the ICU were associated with lower overall satisfaction scores (p = 0.039). Despite some criticism of waiting times and noise levels, responses showed sincere gratitude for patients’ treatment in the ICU and appreciation for the care, skill, and professionalism of the staff.ConclusionVery high satisfaction levels were reported by family members during this study. Routine, prospective evaluations of family member satisfaction with ICU experiences are feasible and can be leveraged to provide insight for clinicians and administrators seeking to improve family satisfaction with decision-making and care in ICU settings and meet national standards.     

The incidence and characteristics of ventilator-associated pneumonia in a regional nontertiary Australian intensive care unit: A retrospective clinical audit study

BackgroundVentilator-associated pneumonia (VAP) is a common complication of mechanical ventilation in the intensive care unit. The incidence, patient characteristics, and outcomes have not been described in a regional Australian setting.ObjectivesΤhe primary objective was to establish the incidence of VAP in a regional intensive care unit using predetermined diagnostic criteria. The secondary objective was to compare the agreement between criteria-based and physician-based diagnostic processes. The tertiary objectives were to compare patient characteristics and clinical outcomes of cases with and without VAP.MethodsA retrospective clinical audit was performed of adult patients admitted to Rockhampton Intensive Care Unit, Australia, between 2013 and 2016. We included all patients ventilated for ≥72 h and not diagnosed with a pneumonia before or during the first 72 h of ventilation.ResultsA total of 170 cases met the inclusion criteria. The incidence of VAP as per the criteria-based diagnosis was 27.3 cases per 1000 ventilator days (95% confidence interval [CI]: 18.4–36.2) and as per the physician-based diagnosis was 25.8 cases per 1000 ventilator days (95% CI: 17.1–34.4). There was a moderate chance-corrected agreement between the criteria- and physician-based diagnosis. Very obese cases (body mass index [BMI] ≥40) were nearly four times more likely to develop VAP than cases with normal BMI (BMI <30) (odds ratio: 3.664; 95% CI: 1.394–9.634; p = 0.008). After controlling for sex, BMI category, comorbidities, and Acute Physiology and Chronic Health Evaluation II scores, there was a trend (p = 0.283) for higher adjusted mortality rate for cases with VAP (10.1%, 95% CI: 4.8–21.5) than for those without VAP (6.1%, 95% CI: 3.0–12.4). Cases with VAP had a higher total hospital cost ($123,223 AUD vs $66,425 AUD, p < 0.001), than cases without VAP.ConclusionsThis is the first study reporting incidence of VAP in an Australian regional intensive care unit setting. An increased length of stay and significantly higher hospital costs warrant research investigating reliable and valid clinical prediction rules to forecast those at risk of VAP.     

Poor outcomes of delirium in the intensive care units are amplified by increasing age: A retrospective cohort study

BACKGROUND: Delirium in patients in intensive care units(ICUs) is an acute disturbance and fluctuation of cognition and consciousness. Though increasing age has been found to be related to ICU delirium, there is limited evidence of the effect of age on delirium outcomes. The aim of this study is to investigate the relationship between age categories and outcomes among ICU delirium patients.METHODS: Data were extracted from the electronic ICU(e ICU) Collaborative Research Database with records from 3,931 patients with delirium. Patients were classified into non-aged(<65 years), youngold(65–74 years), middle-old(75–84 years), and very-old(≥85 years) groups. A Cox regression model was built to examine the role of age in death in ICU and in hospital after controlling covariates. RESULTS: The sample included 1,667(42.4%) non-aged, 891(22.7%) young-old, 848(21.6%) middle-old, and 525(13.3%) very-old patients. The ICU mortality rate was 8.3% and the hospital mortality rate was 15.4%. Compared with the non-aged group, the elderly patients(≥65 yeras) had higher mortality at ICU discharge(χ2=13.726, P=0.001) and hospital discharge(χ2=56.347, P<0.001). The Cox regression analysis showed that age was an independent risk factor for death at ICU discharge(hazard ratio [HR]=1.502, 1.675, 1.840, 95% confidence interval [CI] 1.138–1.983, 1.250–2.244, 1.260–2.687;P=0.004, 0.001, 0.002 for the young-, middle-and very-old group, respectively) as well as death at hospital discharge(HR=1.801, 2.036, 2.642, 95% CI 1.454–2.230, 1.638–2.530, 2.047–3.409;all P<0.001).CONCLUSIONS: The risks of death in the ICU and hospital increase with age among delirious patients.     

Association between nursing cost and patient outcomes in intensive care units: A retrospective cohort study of Belgian hospitals

IntroductionHospitals with better nursing resources report more favourable patient outcomes with almost no difference in cost as compared to those with worse nursing resources. The aim of this study was to assess the association between nursing cost per intensive care unit bed and patient outcomes (mortality, readmission, and length of stay).MethodologyThis was a retrospective cohort study using data collected from the intensive care units of 17 Belgian hospitals from January 01 to December 31, 2018. Hospitals were dichotomized using median annual nursing cost per bed. A total of 18,235 intensive care unit stays were included in the study with 5,664 stays in the low-cost nursing group and 12,571 in the high-cost nursing group.ResultsThe rate of high length of stay outliers in the intensive care unit was significantly lower in the high-cost nursing group (9.2% vs 14.4%) compared to the low-cost nursing group. Intensive care unit readmission was not significantly different in the two groups. Mortality was lower in the high-cost nursing group for intensive care unit (9.9% vs 11.3%) and hospital (13.1% vs 14.6%) mortality. The nursing cost per intensive care bed was different in the two groups, with a median [IQR] cost of 159,387€ [140,307–166,690] for the low-cost nursing group and 214,032€ [198,094–230,058] for the high-cost group.In multivariate analysis, intensive care unit mortality (OR = 0.80, 95% CI: 0.69–0.92, p < 0.0001), in-hospital mortality (OR = 0.82, 95% CI: 0.72–0.93, p < 0.0001), and high length of stay outliers (OR = 0.48, 95% CI: 0.42–0.55, p < 0.0001) were lower in the high-cost nursing group. However, there was no significant effect on intensive care readmission between the two groups (OR = 1.24, 95% CI: 0.97–1.51, p > 0.05).ConclusionsThis study found that higher-cost nursing per bed was associated with significantly lower intensive care unit and in-hospital mortality rates, as well as fewer high length of stay outliers, but had no significant effect on readmission to the intensive care unit..     

A nurse-led critical care outreach program to reduce readmission to the intensive care unit: A quasi-experimental study with a historical control group

IntroductionVarious critical care outreach services have been developed and evaluated worldwide; however, the conflicting findings indicate the need to strengthen the outreach service research. This study aimed to evaluate the effects of a nurse-led critical care follow-up program on intensive care unit (ICU) readmission and hospital mortality in patients with respiratory problems discharged from the ICU in Hong Kong.MethodsA quasi-experimental study design, with a historical control and a prospective intervention for 13 months, was used. The intervention group received a nurse-led, multidisciplinary ICU follow-up program in addition to the usual care. The outcome measures included ICU readmission within 72 h after ICU discharge, all ICU readmission (ICU readmission irrespective of the time frame after ICU discharge), hospital mortality, and 90-day mortality rate. Logistic regression analysis was used to determine the predictors for ICU readmission within 72 h.ResultsA total of 369 participants (the intervention group: 185; the control group: 184) were recruited. A significant reduction in ICU readmission within 72 h was observed in the intervention group compared to the control group (p = 0.001), even after controlling for confounders (odds ratio: 0.158, p = 0.007). The intervention group also demonstrated a significant reduction in all ICU readmission (p < 0.001) and hospital mortality (p = 0.042), but not on 90-day mortality (p = 0.081), when compared with the control group. This nurse-led ICU follow-up program was shown to be cost-effective, saving an estimated US$ 145,614 for a period of 13 months.ConclusionThe findings demonstrated that a nurse-led multidisciplinary ICU follow-up program was a beneficial and cost-saving strategy to avert ICU readmission in patients with respiratory problems after ICU discharge. It also highlighted the competent role of ICU nurses in planning and leading the implementation of a multidisciplinary program. The results contributed to the database of an innovative follow-up program to inform the practice worldwide.     

Adverse drug reactions and deliberate self-poisoning as cause of admission to the intensive care unit: a 1-year prospective observational cohort study

Objective

The aim of the present study was (1) to determine the prevalence of intensive care unit (ICU) admissions due to an adverse drug reaction (ADR), and (2) to compare affected patients with patients admitted to the ICU for the treatment of deliberate self-poisoning using medical drugs.

Design

Prospective observational cohort study.

Setting

Fourteen bed medical ICU including an integrated intermediate care (IMC) section at a tertiary referral center.

Patients

A total of 1,554 patients admitted on 1 January 2003 to 31 December 2003.

Results

Ninety-nine patients were admitted to the ICU with a diagnosis of ADR (6.4% of all admissions), 269 admissions (17.3%) were caused by deliberate self-poisoning. Patients admitted for treatment of ADR had a significantly higher age, a longer treatment duration in the ICU, a higher SAPS II score, and a higher 6-month mortality than those with deliberate self-poisoning. Most patients (71.7%) suffering from ADR required advanced supportive care in the ICU while the majority of patients (90.7%) with deliberate self-poisoning could be sufficiently treated in the IMC area. All diagnostic and therapeutic procedures in the ICU except mechanical ventilation were significantly more often performed in patients with ADR.

Conclusions

This study provides further evidence that ADR is a frequent cause of admission to medical ICUs resulting in a considerable use of ICU capacities. In the present setting patients with ADR required longer and more intense medical treatment in the ICU than those with deliberate self-poisoning.

     

Preadmission quality of life can predict mortality in intensive care unit—A prospective cohort study

Purpose

We sought to investigate whether preadmission quality of life could act as a predictor of mortality among patients admitted to the intensive care unit (ICU).

Materials and methods

This is a prospective observational study of all patients above the age of 18 years admitted to the ICU with a length of stay longer than 24 hours. Short form 36 (SF-36) and Acute Physiology and Chronic Health Evaluation II (APACHE II) were used. Mortality was assessed during ICU admission, 30, and 90 days hereafter.

Results

We included 318 patients. No patients were lost to follow-up. Using the physical component summary of short form 12 (SF-12) as a predictor of ICU mortality, the area under the curve (0.70; confidence interval, 0.62-0.77) was comparable with that of APACHE II (0.74; confidence interval, 0.67-0.82). The difference between SF-12 and SF-36 was nonsignificant.

Conclusions

Preadmission quality of life, assessed by SF-36 and SF-12, is as good at predicting ICU, 30-, and 90-day mortality as APACHE II in patients admitted to the ICU for longer than 24 hours. This indicates that estimated preadmission quality of life, potentially available in the pre-ICU setting, could aid decision making regarding ICU admission and deserves more attention by those caring for critically ill patients.     

Cost effectiveness of intensive care in a low resource setting: A prospective cohort of medical critically ill patients

AIM: To calculate cost effectiveness of the treatment of critically ill patients in a medical intensive care unit (ICU) of a middle income country with limited access to ICU resources. METHODS: A prospective cohort study and economic evaluation of consecutive patients treated in a recently established medical ICU in Sarajevo, Bosnia and Herzegovina. A cost utility analysis of the intensive care of critically ill patients compared to the hospital ward treatment from the perspective of the health care system was subsequently performed. Incremental cost effectiveness was calculated using estimates of ICU vs non-ICU treatment effectiveness based on a formal systematic review of published studies. Decision analytic modeling was used to compare treatment alternatives. Sensitivity analyses of the key model parameters were performed. RESULTS: Out of 148 patients, seventy patients (47.2%) survived to one year after critical illness with a median quality of life index 0.64 [interquartile range(IQR) 0.49-0.76]. Median number of life years gained per patient was 30 (IQR 16-40) or 18 quality adjusted life years (QALYs) (IQR 7-28). The cost of treatment of critically ill patients varied between 1820 dollar and 20109 dollar per hospital survivor and between 100 dollar and 2514 dollar per QALY saved. Mean factors that influenced costs were: Age, diagnostic category, ICU and hospital length of stay and number and type of diagnostic and therapeutic interventions. The incremental cost effectiveness ratio for ICU treatment was estimated at 3254 dollar per QALY corresponding to 35% of per capita GDP or a Very Cost Effective category according to World Health Organization criteria. CONCLUSION: The ICU treatment of critically ill medical patients in a resource poor country is cost effective and compares favorably with other medical interventions. Public health authorities in low and middle income countries should encourage development of critical care services.     

外科重症监护病房患者的重返原因及预后危险因素分析

目的 探讨外科重症监护病房(SICU)患者的重返原因以及影响患者预后的危险因素.方法 收集2009年1月至2012年2月本院SICU 7381例患者中178例重返患者的资料,采用回顾性方法分析患者的重返原因,采用单因素分析和多元逐步回归分析筛选及判定与重返患者预后相关的危险因素.结果 患者重返SICU的发生率为2.41％(178/7381).178例重返患者中有39.89％(71/178)年龄超过70岁;有46.07％ (82/178)在转出SICU 48 h内再次转入.重返SICU患者的病死率为37.08％(66/178),死亡组(66例)首次转出SICU、重返SICU时的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ,分)均显著高于存活组(112例,9.15±4.13比7.74±3.62,18,47±5.67比12.99±6,32,P＜0.05和P＜0.01),重返SICU时的格拉斯哥昏迷评分(GCS,分)显著低于存活组(10.88±4.37比12.37±2.68,P＜0.01).重返SICU患者最常见的重返原因为呼吸系统并发症和手术相关并发症.死亡组合并脓毒症、感染性休克、多器官功能障碍综合征(MODS)的发生率显著高于存活组(22.7％比7.1％,19.7％比7.1％,10.6％比0,均P＜0.05).经多元逐步回归分析显示,重返SICU时APACHEⅡ评分、合并MODS是影响重返SICU患者预后的独立危险因素(t=5.0163、P=0.0000,t=2.3641、P=0.0192).结论 严格掌握SICU转出指征,对转出患者进行动态APACHEⅡ评分和GCS评分,积极防治呼吸系统并发症和手术相关并发症,以减少患者重返SICU发生率.     

A relational coordination training intervention to improve job satisfaction and intent to stay in the intensive care unit: A pilot study

BackgroundRelational coordination (RC) explores the coordination of work between and among professionals in a workgroup. RC is associated with higher job satisfaction and retention; however, researchers have not tested RC training interventions to improve job satisfaction and retention.PurposeTo explore changes in job satisfaction and intent to stay among health care professionals following a virtual RC training intervention.MethodsWe conducted a pilot, parallel group randomized controlled trial in four intensive care units. Data collection occurred via survey. Difference-in-difference regression models were used to analyze the job satisfaction and intent to stay outcomes.DiscussionThe RC training intervention did not influence job satisfaction or intent to stay. Participants with baccalaureate degrees and African American/Black participants reported lower intent to stay.ConclusionThe results from this pilot study are a critical first step in testing the efficacy of an RC training intervention to improve staff outcomes in a larger powered study.     

危重孕产妇住重症监护病房时间延长的危险因素分析——北京市3家医院5年回顾性研究

目的 评估危重孕产妇重症监护病房(ICU)住院时间延长的危险因素.方法 回顾性分析2006年1月1日至2010年12月31日北京市3家医院ICU危重孕产妇的临床资料,包括患者的基本特征、转入ICU的疾病种类、急性生理学与慢性健康状况评分系统I(APACHE I)评分、发病至转入ICU时间、各种检查结果、治疗措施、ICU住院时间以及孕产妇病死率.采用单因素比较和多因素Logistic回归分析危重孕产妇ICU住院时间延长的危险因素.结果 5年内共有207例危重孕产妇收入ICU,占所有孕产妇的0.42%;平均年龄(31.74±2.32)岁,平均孕龄(34.86+4.72)周.其中4例孕产妇死亡,病死率1.93%.207例危重孕产妇中,138例为产科重症,69例并发严重内科疾病.转入ICU最常见的产科病因为产后大出血(42例,20.29%)和妊娠相关性高血压(36例,17.39%),其次为妊娠急性脂肪肝(AFLP,27例,13.04%)和产科弥散性血管内凝血(DIC,23例,11.11%);最常见的内科病因为急性心功能衰竭(26例,12.56%)和急性呼吸衰竭(22例,10.63%),其次为重症急性胰腺炎(SAP,11例,5.31%).109例患者(占52.66%)ICU住院时间延长(ICU滞留时间＞3 d).单因素分析显示,未行规律产前检查、血肌酐、凝血酶原时间国际标准化比值(INR)、氧合指数(PaO2/FiO2)、AFLP、产科DIC、SAP、机械通气、血管活性药物、血液净化治疗和发病至转入ICU时间＞24 h与ICU住院时间延长有关.多因素Logistic回归分析显示,未行规律产前检查[优势比(OR)1.68,95%可信区间(95%CI)1.14～2.69,P=0.011]、PaO2/FiO2(OR 4.73,95%CI 1.46～11.37,P=0.013)、AFLP(OR 3.21,95%CI 1.13～4.76,P=0.026)、产科DIC(OR 2.73,95%CI 1.28～4.02,P=0.018)、SAP(OR 4.78,95%CI 1.83～7.42,P=0.021)、血管活性药物(OR 1.96,95%CI 1.24～3.15,P=0.001)、血液净化治疗(OR 11.02,95%CI 3.04～58.02,P=0.015)和发病至转入ICU时间＞24 h(OR 2.04,95%CI 1.21～4.25,P＜0.001)是ICU住院时间延长的独立危险因素.结论 危重孕产妇ICU住院时间延长的发生率较高.临床上可以根据危险因素预测危重孕产妇ICU住院时间延长,加强规律产前检查、避免产科及内科严重并发症;发病后尽快转入ICU并在ICU内加强各器官功能支持可能有助于缩短ICU住院时间.