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首页> 外文期刊>BMC Emergency Medicine >Impact of introducing multiple evidence-based clinical practice protocols in a medical intensive care unit: a retrospective cohort study
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Impact of introducing multiple evidence-based clinical practice protocols in a medical intensive care unit: a retrospective cohort study

机译：在重症监护病房中引入多种循证临床实践方案的影响：一项回顾性队列研究

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Background Recently completed clinical trials have shown that certain interventions improve the outcome of the critically ill. To facilitate the implementation of these interventions, professional organizations have developed guidelines. Although the impacts of the individual evidence-based interventions have been well described, the overall impact on outcome of introducing multiple evidence-based protocols has not been well studied. The objective of this study was to determine the impact of introducing multiple evidence-based protocols on patient outcome. Methods A retrospective, cohort study of 8,386 patients admitted to the medical intensive care unit (MICU) of an academic, tertiary medical center, from January 2000 through June 2005 was performed. Four evidence-based protocols (lung protective strategy for acute lung injury, activated protein C for severe sepsis/septic shock, intravenous insulin for hyperglycemia control and a protocol for sedation/analgesia) were introduced in the MICU between February 2002 and April 2004. We considered the time from January 2000 through January 2002 as the pre-protocol period, from February 2002 through March 2004 as the transition period and from April 2004 through June 2005 as the protocol period. We retrieved data including demographics, severity of illness as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) III, MICU length of stay and hospital mortality. Student's t, Kruskal-Wallis, Mann-Whitney U, chi square and multiple logistic regression analyses were used to compare differences between groups. P-values Results The predicted mean mortality rates were 20.7%, 21.1% and 21.8%, with the observed mortality rates of 19.3%, 18.0% and 16.9% during the pre-protocol, transition and protocol periods, respectively. Using the pre-protocol period as a reference, the severity-adjusted risk (95% confidence interval) of dying was 0.777 (0.655 – 0.922) during the protocol period (P = 0.0038). The average 28-day MICU free days improved during the protocol period compared to the pre-protocol period. The benefit was limited to sicker patients and those who stayed in the MICU longer. Conclusion The introduction of multiple evidence-based protocols is associated with improved outcome in critically ill medical patients.
机译：背景技术最近完成的临床试验表明，某些干预措施可以改善重症患者的预后。为了促进实施这些干预措施，专业组织已制定了准则。尽管已经很好地描述了各个基于证据的干预措施的影响，但是对引入多种基于证据的方案对结果的总体影响还没有得到很好的研究。这项研究的目的是确定引入多种基于证据的方案对患者预后的影响。方法对2000年1月至2005年6月在学术，三级医学中心的医学重症监护室（MICU）收治的8,386名患者进行了一项回顾性队列研究。在2002年2月至2004年4月间，MICU引入了四种基于证据的方案（急性肺损伤的肺保护策略，严重脓毒症/败血症性休克的活化蛋白C，高血糖控制的静脉注射胰岛素和镇静/镇痛方案）。将2000年1月至2002年1月的时间作为协议前的期限，将2002年2月至2004年3月的时间作为过渡期，并将2004年4月至2005年6月的时间作为协议期限。我们检索了包括人口统计学，疾病的严重程度（通过急性生理和慢性健康评估（APACHE）III），MICU住院时间和住院死亡率的数据。使用学生t检验，Kruskal-Wallis检验，Mann-Whitney U检验，卡方检验和多元Logistic回归分析比较两组之间的差异。 P值结果预测的平均死亡率在协议开始前，过渡时期和治疗方案期间分别为20.7％，21.1％和21.8％，观察到的死亡率分别为19.3％，18.0％和16.9％。以协议前阶段为参考，在协议期内，死亡的经过严重程度调整的死亡风险（95％置信区间）为0.777（0.655 – 0.922）（P = 0.0038）。与协议前相比，协议期间的平均28天MICU免费天数有所改善。受益仅限于病情较重的患者以及在MICU停留时间更长的患者。结论引入多种基于证据的方案可以改善危重病患者的预后。

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