Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study

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• 作者：Maurizia Capuzzo (1)
  Carlo Alberto Volta (1)
  Tania Tassinati (1)
  Rui Paulo Moreno (2)
  Andreas Valentin (3)
  Bertrand Guidet (4) (5)
  Gaetano Iapichino (6)
  Claude Martin (7)
  Thomas Perneger (8)
  Christophe Combescure (8)
  Antoine Poncet (8)
  Andrew Rhodes (9)
  on behalf of the Working Group on Health Economics of the European Society of Intensive Care Medicine
  
  1. Section of Anaesthesia and Intensive Care ; Department of Morphology ; Surgery and Experimental Medicine ; S. Anna Hospital ; University of Ferrara ; Via Aldo Moro 8 ; 44124 Cona ; Ferrara ; Italy
  2. Unidade de Cuidados Intensivos Neurocr铆ticos ; Hospital de S茫o Jos茅 ; Centro Hospitalar de Lisboa Central ; Rua Jos茅 Ant贸nio Serrano Lisboa ; 1150-199 ; Portugal
  3. Rudolfstiftung Hospital and Medical University of Vienna ; General and Medical Intensive Care Unit (Rudolfstiftung Hospital) ; Juchgasse 25 ; 1030 ; Vienna ; Austria
  4. Assistance Publique - H么pitaux de Paris ; H么pital Saint-Antoine ; Service de R茅animation M茅dicale ; 184 rue du Faubourg Saint-Antoine ; Paris ; F-75012 ; France
  5. UPMC Univ Paris 06 ; Inserm ; Unit茅 de Recherche en 脡pid茅miologie Syst猫mes d鈥橧nformation et Mod茅lisation (U707) ; 4 Place Jussieu ; Paris ; F-75012 ; France
  6. Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti ; Universit脿 degli Studi di Milano ; Polo Universitario San Paolo ; Via Ovada 26 ; 20142 ; Milan ; Italy
  7. Department of Anaesthesia and Intensive Care ; H么pital Nord ; Chemin des Bourrely ; F-13015 ; Marseille ; France
  8. Division of Clinical Epidemiology ; University Hospitals of Geneva and University of Geneva ; 24 Micheli-du-Crest ; CH-1211 ; Geneva ; Switzerland
  9. Department of Intensive Care Medicine ; St George鈥檚 Healthcare NHS Trust and University of London ; Blackshaw Road ; London ; SW17 0QT ; UK
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：October 2014
• 年：2014
• 卷：18
• 期：5
• 全文大小：430 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction The aim of the study was to assess whether adults admitted to hospitals with both Intensive Care Units (ICU) and Intermediate Care Units (IMCU) have lower in-hospital mortality than those admitted to ICUs without an IMCU. Methods An observational multinational cohort study performed on patients admitted to participating ICUs during a four-week period. IMCU was defined as any physically and administratively independent unit open 24聽hours a day, seven days a week providing a level of care lower than an ICU but higher than a ward. Characteristics of hospitals, ICUs and patients admitted to study ICUs were recorded. The main outcome was all-cause in-hospital mortality until hospital discharge (censored at 90聽days). Results One hundred and sixty-seven ICUs from 17 European countries enrolled 5,834 patients. Overall, 1,113 (19.1%) patients died in the ICU and 1,397 died in hospital, with a total of 1,397 (23.9%) deaths. The illness severity was higher for patients in ICUs with an IMCU (median Simplified Acute Physiology Score (SAPS) II: 37) than for patients in ICUs without an IMCU (median SAPS II: 29, P P = 0.007) in favour of the presence of IMCU. The protective effect of the IMCU was absent in patients who were admitted for basic observation, for example, after surgery (odds ratio 1.15, 95% CI 0.65 to 2.03, P = 0.630) but was strong in patients admitted to an ICU for other reasons (odds ratio 0.54, 95% CI 0.37 to 0.80, P = 0.002). Conclusions The presence of an IMCU in the hospital is associated with significantly reduced adjusted hospital mortality for adults admitted to the ICU. This effect is relevant for the patients requiring full intensive treatment. Trial registration Clinicaltrials.gov NCT01422070. Registered 19 August 2011.