Protocols and Hospital Mortality in Critically Ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study

被引：38

作者：

Sevransky, Jonathan E. ^{[1
]}

Checkley, William ^{[2
]}

Herrera, Phabiola ^{[2
]}

Pickering, Brian W. ^{[3
]}

Barr, Juliana ^{[4
]}

Brown, Samuel M. ^{[5
,6
]}

Chang, Steven Y. ^{[7
]}

Chong, David ^{[8
]}

Kaufman, David ^{[9
]}

Fremont, Richard D. ^{[10
]}

Girard, Timothy D. ^{[11
,12
]}

Hoag, Jeffrey ^{[13
]}

Johnson, Steven B. ^{[14
]}

Kerlin, Mehta P. ^{[15
]}

Liebler, Janice ^{[16
]}

O'Brien, James ^{[17
]}

O'Keefe, Terence ^{[18
]}

Park, Pauline K. ^{[19
]}

Pastores, Stephen M. ^{[20
]}

Patil, Namrata ^{[21
]}

Pietropaoli, Anthony P. ^{[22
]}

Putman, Maryann ^{[23
]}

Rice, Todd W. ^{[11
,12
]}

Rotello, Leo ^{[24
]}

Siner, Jonathan ^{[9
]}

Sajid, Sahul ^{[25
]}

Murphy, David J. ^{[1
]}

Martin, Greg S. ^{[1
]}

机构：

[1] Emory Univ, Div Pulm Allergy & Crit Care, Atlanta, GA 30322 USA

[2] Johns Hopkins Univ, Div Pulm & Crit Care, Baltimore, MD USA

[3] Mayo Clin, Dept Anesthesia, Rochester, MN USA

[4] Stanford Univ, Dept Anesthesiol, Palo Alto, CA 94304 USA

[5] Intermt Med Ctr, Div Pulm & Crit Care, Salt Lake City, UT USA

[6] Univ Utah, Salt Lake City, UT USA

[7] Univ Calif Los Angeles, Div Pulm & Crit Care, Los Angeles, CA USA

[8] Columbia Univ, Med Ctr, Div Pulm & Crit Care Med, New York, NY USA

[9] Yale Univ, Sch Med, Sect Pulm & Crit Care Med, New Haven, CT USA

[10] Meharry Med Coll, Div Pulm & Crit Care, Nashville, TN 37208 USA

[11] Vanderbilt Univ, Sch Med, Div Allergy Pulm & Crit Care Med, Nashville, TN 37212 USA

[12] Vanderbilt Univ, Sch Med, Ctr Hlth Serv Res, Nashville, TN 37212 USA

[13] Drexel Univ, Div Pulm & Crit Care, Philadelphia, PA 19104 USA

[14] Univ Maryland, Dept Surg Crit Care, Baltimore, MD 21201 USA

[15] Univ Penn, Div Pulm Allergy & Crit Care, Philadelphia, PA 19104 USA

[16] Univ So Calif, Div Pulm Crit Care & Sleep Med, Los Angeles, CA USA

[17] Ohio State Univ, Div Pulm Allergy Crit Care & Sleep Med, Columbus, OH 43210 USA

[18] Univ Arizona, Dept Surg, Tucson, AZ USA

[19] Univ Michigan Hlth Syst, Dept Surg, Div Acute Care Surg, Ann Arbor, MI USA

[20] Mem Sloan Kettering Canc Ctr, Dept Anesthesiol & Crit Care Med, New York, NY 10021 USA

[21] Brigham & Womens Hosp, Dept Surg, Div Thorac Surg, Div Trauma Burn & Crit Care, Boston, MA 02115 USA

[22] Univ Rochester, Div Pulm & Crit Care Med, Rochester, NY USA

[23] INOVA Fairfax Hosp, Falls Church, VA USA

[24] Suburban Hosp, Bethesda, MD USA

[25] Beth Israel Deaconess Med Ctr, Dept Anesthesia, Boston, MA 02215 USA

来源：

CRITICAL CARE MEDICINE | 2015年 / 43卷 / 10期

基金：

美国国家卫生研究院;

关键词：

intensive care unit; mortality; protocol; TIDAL VOLUME VENTILATION; INTENSIVE-CARE UNITS; ACUTE LUNG INJURY; MECHANICAL VENTILATION; COMPUTERIZED PROTOCOLS; ORGANIZATIONAL-FACTORS; CLINICAL PROTOCOLS; SEVERE SEPSIS; IMPLEMENTATION; IMPROVEMENT;

D O I：

10.1097/CCM.0000000000001157

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objective: Clinical protocols may decrease unnecessary variation in care and improve compliance with desirable therapies. We evaluated whether highly protocolized ICUs have superior patient outcomes compared with less highly protocolized ICUs. Design: Observational study in which participating ICUs completed a general assessment and enrolled new patients 1 day each week. Patients: A total of 6,179 critically ill patients. Setting: Fifty-nine ICUs in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study. Interventions: None. Measurements and Main Results: The primary exposure was the number of ICU protocols; the primary outcome was hospital mortality. A total of 5,809 participants were followed prospectively, and 5,454 patients in 57 ICUs had complete outcome data. The median number of protocols per ICU was 19 (interquartile range, 15-21.5). In single-variable analyses, there were no differences in ICU and hospital mortality, length of stay, use of mechanical ventilation, vasopressors, or continuous sedation among individuals in ICUs with a high versus low number of protocols. The lack of association was confirmed in adjusted multivariable analysis (p = 0.70). Protocol compliance with two ventilator management protocols was moderate and did not differ between ICUs with high versus low numbers of protocols for lung protective ventilation in acute respiratory distress syndrome (47% vs 52%; p = 0.28) and for spontaneous breathing trials (55% vs 51%; p = 0.27). Conclusions: Clinical protocols are highly prevalent in U.S. ICUs. The presence of a greater number of protocols was not associated with protocol compliance or patient mortality.

引用

页码：2076 / 2084

页数：9

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