PDF(Pubmed)
Abstract：
Although medical emergency teams (METs) have been widely introduced, studies on the importance of a dedicated intensivist staffing to METs are lacking. A single-center retrospective before-and-after study was performed. Deteriorating patients who required emergency airway management in general wards by MET were included in this study. We divided the study period according to the presence of a dedicated intensivist staff in MET: (1) non-staffed period (from January 2016 to February 2018, n = 971) and (2) staffed period (from March 2018 to December 2019, n = 651), and compared emergency airway management-related variables and outcomes between the periods. Among 1622 patients included, mean age was 63.0 years and male patients were 64.2% (n = 1042). The first-pass success rate was significantly increased in the staffed period (85.9% in the non-staffed vs 89.2% in the staffed; P = .047). Compliance to rapid sequence intubation was increased (9.4% vs 34.4%; P < .001) and vocal cords were more clearly open (P < .001) in the staffed period. The SpO2/FiO2 ratio (median [interquartile range], 125 [113-218] vs 136 [116-234]; P = .007) and the ROX index (4.6 [3.4-7.6] vs 5.1 [3.6-8.5]; P = .013) at the time of intubation was higher in the staffed period, suggesting the decision on intubation was made earlier. The post-intubation hypoxemia was less commonly occurred in the staffed period (7.2% vs 4.2%, P = .018). In multivariate analysis, the rank of operator was a strong predictor of the first-pass success (adjusted OR [95% CI], 2.280 [1.639-3.172]; P < .001 for fellow and 5.066 [1.740-14.747]; P < .001 for staff, relative to resident). In our hospital, a dedicated intensivist staffing to MET was associated with improved emergency airway management in general wards. Staffing an intensivist to MET needs to be encouraged to improve the performance of MET and the patient safety.
摘要：
虽然医疗急救小组(MET)已经被广泛引入，缺乏关于专门的强化人员配备对MET的重要性的研究。进行单中心回顾性前后研究。本研究包括需要通过MET在普通病房进行紧急气道管理的恶化患者。我们根据MET中专门的强化人员的存在来划分研究期：（1）非人员期间（从2016年1月到2018年2月，n=971）和（2）人员期间（从2018年3月到2019年12月，n=651），并比较了两个时期之间的紧急气道管理相关变量和结果。在1622名患者中，平均年龄为63.0岁,男性患者占64.2%(n=1042).在员工期间，首次通过成功率显着提高（非员工为85.9％，员工为89.2％；P=.047）。在人员配备期间，对快速顺序插管的依从性增加（9.4％vs34.4％；P<.001），声带更明显开放（P<.001）。SpO2/FiO2比值（中位数[四分位数间距]，125[113-218]vs136[116-234]；P=.007）和ROX指数（4.6[3.4-7.6]vs5.1[3.6-8.5]；P=.013）在插管期间较高，这表明插管的决定是早些时候做出的。插管后低氧血症较少发生在工作人员期间(7.2%vs4.2%,P=.018）。在多变量分析中，操作者的等级是首过成功的强预测因子(调整后的OR[95%CI]，2.280[1.639-3.172];P<.001对于研究员和5.066[1.740-14.747];P<.001对于员工,相对于居民)。在我们的医院里,为MET配备专门的重症医师与普通病房改善紧急气道管理相关.需要鼓励为MET配备重症医师，以提高MET的性能和患者的安全性。
