William B. Blackburne MBChB, BMedSc(Hons), Paul J. Young MBChB, PhD, FCICM
{"title":"2009 年和 2023 年澳大利亚和新西兰对重症监护分流的看法","authors":"William B. Blackburne MBChB, BMedSc(Hons), Paul J. Young MBChB, PhD, FCICM","doi":"10.1016/j.ccrj.2023.10.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Design</h3><p>Online Survey.</p></div><div><h3>Setting and Participants</h3><p>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.</p></div><div><h3>Main Outcome Measures</h3><p>Perceived ICU admission behaviours.</p></div><div><h3>Results</h3><p>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).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223005173/pdfft?md5=fdcf748f336da0e420536690d82dd950&pid=1-s2.0-S1441277223005173-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Perceptions of intensive care triage in Australia and New Zealand in 2009 and 2023\",\"authors\":\"William B. Blackburne MBChB, BMedSc(Hons), Paul J. Young MBChB, PhD, FCICM\",\"doi\":\"10.1016/j.ccrj.2023.10.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>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.</p></div><div><h3>Design</h3><p>Online Survey.</p></div><div><h3>Setting and Participants</h3><p>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.</p></div><div><h3>Main Outcome Measures</h3><p>Perceived ICU admission behaviours.</p></div><div><h3>Results</h3><p>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).</p></div><div><h3>Conclusions</h3><p>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.</p></div>\",\"PeriodicalId\":49215,\"journal\":{\"name\":\"Critical Care and Resuscitation\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2023-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1441277223005173/pdfft?md5=fdcf748f336da0e420536690d82dd950&pid=1-s2.0-S1441277223005173-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care and Resuscitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1441277223005173\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care and Resuscitation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1441277223005173","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
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.
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.