2009 年和 2023 年澳大利亚和新西兰对重症监护分流的看法

IF 1.4 4区 医学 Q3 CRITICAL CARE MEDICINE Critical Care and Resuscitation Pub Date : 2023-12-01 DOI:10.1016/j.ccrj.2023.10.001
William B. Blackburne MBChB, BMedSc(Hons), Paul J. Young MBChB, PhD, FCICM
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引用次数: 0

摘要

目的重症监护病房(ICU)床位稀缺,入院决策复杂且受多种因素影响。本研究旨在描述澳大利亚和新西兰在入院决策方面的差异,并与之前的数据进行比较,以确定随时间推移而发生的变化。设计在线调查。设置和参与者向澳大利亚和新西兰的重症监护医生发放了一份在线调查,调查内容包括上周的分诊行为以及对 ICU 分诊情景的反应。分流决定的中位数和被拒绝病人的中位数分别为 6-10 人和 1-5 人。澳大利亚和新西兰的重症监护病房床位数在决策中的作用没有差异。与澳大利亚的重症监护医师相比,新西兰的重症监护医师不太可能收治以下患者:急性髓性白血病(AML)复发、急性呼吸窘迫综合征(ARDS)(p=0.03)、持续植物状态、社区获得性肺炎(p=0.02)或先天性肺炎(p=0.03)。与 2009 年的受访者(n=238)相比,2023 年的受访者更有可能收治以下患者:严重颅内出血可能导致脑死亡(p=0.005)、急性髓细胞白血病复发和 ARDS(p=0.02)、为姑息治疗而中风(p<0.001);更不可能收治持续植物状态和先天性肺炎患者(p=0.03)。在一项多变量分析中,来自澳大利亚的受访者与来自新西兰的受访者相比,以及来自 2023 年的受访者与来自 2009 年的受访者相比,更有可能表示他们会在所述情况下将患者送入重症监护室(两项比较的 p<0.001)。自 2009 年以来,人们对入院态度的变化可能反映了人们对促进器官捐献的重要性以及 ICU 作为姑息治疗提供者的作用的认识有所提高。
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Perceptions of intensive care triage in Australia and New Zealand in 2009 and 2023

Objective

Intensive care (ICU) beds are scarce and decision-making regarding admission is complex and multi-factorial. This study aimed to characterise differences in admission decision making between Australia and New Zealand and compare to previous data to establish changes over time.

Design

Online Survey.

Setting and Participants

An online survey was distributed to Australian and New Zealand intensive care doctors measuring triage behaviours in the last week and responses to ICU triage scenarios.

Main Outcome Measures

Perceived ICU admission behaviours.

Results

103 responses were obtained, 83(80.6%) from Australia and 97 (94.2%) from specialist intensivists. The median number of triage decisions and patients declined were 6-10 and 1-5 respectively. No difference was noted in the role of ICU bed capacity in decision making between Australia and New Zealand. Compared to Australian intensivists, New Zealand intensivists were less likely to admit a patient: with relapsed acute myeloid leukaemia (AML) and acute respiratory distress syndrome (ARDS)(p=0.03), with persistent vegetative state and community acquired (p=0.02) or iatrogenic (p=0.03) pneumonia. Compared to respondents in 2009 (n=238), 2023 respondents were more likely to admit a patient: with a severe intracranial bleed who may become braindead (p=0.005), with relapsed AML and ARDS (p=0.02), with stroke for palliative care (p<0.001); and less likely to admit a patient with persistent vegetative state and iatrogenic pneumonia (p=0.03). In a multivariable analysis, respondents from Australian compared to New Zealand and from 2023 compared to 2009 were more likely to indicate they would admit patients to the ICU in the scenarios described (p<0.001 for both comparisons).

Conclusions

Our study suggests that New Zealand intensivists may apply more restrictive ICU admission criteria than Australian intensivists. Changes in attitudes to admission since 2009 may reflect increased awareness of the importance of facilitating organ donation and the role of ICU as providers of palliative care.

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来源期刊
Critical Care and Resuscitation
Critical Care and Resuscitation CRITICAL CARE MEDICINE-
CiteScore
7.70
自引率
3.40%
发文量
44
审稿时长
>12 weeks
期刊介绍: ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.
期刊最新文献
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