Abstract

Purpose

There is conflicting evidence regarding the influence of intensive care unit (ICU) occupancy at the time of admission on important patient outcomes such as mortality. The objective of this analysis was to characterize the association between ICU occupancy at the time of ICU admission and subsequent mortality.

Methods

This single-centre, retrospective cohort study included all patients admitted to the ICU at the Vancouver General Hospital between 4 January 2010 and 8 October 2017. Intensive care unit occupancy was defined as the number of ICU bed hours utilized in a day divided by the total amount of ICU bed hours available for that day. We constructed mixed-effects logistic regression models controlling for relevant covariates to assess the impact of admission occupancy quintiles on total inpatient (ICU and ward) and early (72-hr) ICU mortality.

Results

This analysis included 10,365 ICU admissions by 8,562 unique patients. Compared with ICU admissions in the median occupancy quintile, admissions in the highest and second highest occupancy quintile were associated with a significant increase in the odds of inpatient mortality (highest: odds ratio [OR], 1.33; 95% confidence interval [CI], 1.12 to 1.59; P value < 0.001; second highest: OR, 1.21; 95% CI, 1.02 to 1.44; P value < 0.03). No association between admission occupancy and 72-hr ICU mortality was observed.

Conclusions

Admission to the ICU on days of high occupancy was associated with increased inpatient mortality, but not with increased 72-hr ICU mortality. Capacity strain on the ICU may result in significant negative consequences for patients, but further research is needed to fully characterize the complex effects of capacity strain.

中文翻译：

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入院期间重症监护病房占用与住院死亡率的关联：一项回顾性队列研究

摘要

目的

关于入院时重症监护病房（ICU）占用对重要患者结局（例如死亡率）的影响，有相互矛盾的证据。该分析的目的是表征入ICU时ICU占用率与随后的死亡率之间的关系。

方法

这项单中心，回顾性队列研究纳入了2010年1月4日至2017年10月8日在温哥华综合医院入住ICU的所有患者。重症监护病房占用率定义为一天中使用ICU床时数除以总床位数。当天可用的ICU上床时间。我们构建了控制相关协变量的混合效应逻辑回归模型，以评估入院五分位数对住院总人数（ICU和病房）和早期（72小时）ICU死亡率的影响。

结果

该分析包括8,562名独特患者的10365例ICU入院。与中位数入住五分位数的ICU入院相比，入住五分位数最高和第二高的入院与住院死亡率的几率显着相关（最高：优势比[OR]，1.33； 95％置信区间[CI]， 1.12至1.59；P值<0.001；第二高：OR，1.21； 95％CI，1.02至1.44；P值<0.03）。没有观察到入院率和72小时ICU死亡率之间的关联。

结论

高占用天数进入ICU与住院死亡率增加相关，但与72小时ICU死亡率增加无关。ICU上的容量紧张可能会给患者带来严重的负面后果，但是需要进一步研究以充分表征容量紧张的复杂影响。