Impact of neurointensivist-managed intensive care unit implementation on patient outcomes after aneurysmal subarachnoid hemorrhage

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• 作者：Satoshi Egawa ; MD^a ; ^{s.egawa7701@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Toru Hifumi ; MD^a ; ^{hifumitoru@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Kenya Kawakita ; MD ; PhD^a ; ^{kenfact@kms.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Masanobu Okauchi ; MD ; PhD^b ; ^{okauchi@med.kagawa-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Atsushi Shindo ; MD ; PhD^b ; ^{ashindo@kms.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Masahiko Kawanishi ; MD ; PhD^b ; ^{mk@kms.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Takashi Tamiya ; MD ; PhD^b ; ^{tamiya@kms.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Yasuhiro Kuroda ; MD ; PhD^a ; ^{kuroday@kms.ac.jp" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Neurocritical care ; Hunt and Kosnik grades ; Aneurysmal subarachnoid hemorrhage ; Modified Ranking Scale ; Neurointensivist
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：32
• 期：Complete
• 页码：52-55
• 全文大小：232 K

文摘

The purpose of the study is to evaluate the impact of neurointensivist-managed intensive care unit (NIM-ICU) implementation for patients admitted with aneurysmal subarachnoid hemorrhage (SAH).

Methods

This study retrospectively evaluated 234 patients (mean age, 61.7 years; male, 67) admitted with SAH between January 1, 2001, and March 31, 2014. Neurologic outcomes between patients admitted from January 2001 to December 2006 (intensivist-managed intensive care unit group) and January 2007 to March 2014 (NIM-ICU group) were compared. The primary outcome was the incidence of a good neurologic outcome at discharge (GO; the modified Ranking Scale score: GO, 0-2; poor neurological outcome, 3-6) at discharge.

Results

Neurointensivist-managed intensive care unit was initiated for 151 (64.5%) of 234 patients. Univariate analysis demonstrated significantly better outcomes for NIM-ICU group vs intensivist-managed intensive care unit group (GOs, 58.3% vs 41.0%, respectively, P = .01). Multivariate logistic regression was used to evaluate NIM-ICU efficacy for SAH patients, but NIM-ICU was not significantly associated with GOs (P = .054). Subgroup analysis of patient grading by Hunt and Kosnik grades I to II showed that NIM-ICU implementation was an independent predictor of GOs (odds ratio, 4.54; 95% confidence interval, 1.08-22.17; P = .04).

Conclusion

Neurointensivist-managed intensive care unit may improve neurologic outcomes in SAH patients with Hunt and Kosnik grades I to II.