临床时讯 ＞ 临床研究
若能将某些未达严重社区获得性肺炎主要标准的患者，在急诊时直接收入ICU可能效果更好。相关论文发表于《危重医学》杂志（Critical Care Medicine）。
Crit Care Med. 2009 Nov;37(11):2867-74.
Association between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia.
Renaud B, Santin A, Coma E, Camus N, Van Pelt D, Hayon J, Gurgui M, Roupie E, Hervé J, Fine MJ, Brun-Buisson C, Labarère J.
Department of Emergency Medicine, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France.
OBJECTIVE: To compare the 28-day mortality and hospital length of stay of patients with community-acquired pneumonia who were transferred to an intensive care unit on the same day of emergency department presentation (direct-transfer patients) with those subsequently transferred within 3 days of presentation (delayed-transfer patients). DESIGN: Secondary analysis of the original data from two North American and two European prospective, multicenter, cohort studies of adult patients with community-acquired pneumonia. PATIENTS: In all, 453 non-institutionalized patients transferred within 3 days of emergency department presentation to an intensive care unit were included in the analysis. Supplementary analysis was restricted to patients without an obvious indication for immediate transfer to an intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The sample consisted of 138 delayed-transfer and 315 direct-transfer patients, among whom 150 (33.1%) were considered to have an obvious indication for immediate intensive care unit admission. After adjusting for the quintile of propensity score, delayed intensive care unit transfer was associated with an increased odds ratio for 28-day mortality (2.07; 95% confidence interval, 1.12-3.85) and a decreased odds ratio for discharge from hospital for survivors (0.53; 95% confidence interval, 0.39-0.71). In a propensity-matched analysis, delayed-transfer patients had a higher 28-day mortality rate (23.4% vs. 11.7%; p = 0.02) and a longer median hospital length of stay (13 days vs. 7 days; p < .001) than direct-transfer patients. Similar results were found after excluding the 150 patients with an obvious indication for immediate intensive care unit admission. CONCLUSIONS: Our findings suggest that some patients without major criteria for severe community-acquired pneumonia, according to the recent Infectious Diseases Society of America/American Thoracic Society consensus guideline, may benefit from direct transfer to the intensive care unit. Further studies are needed to prospectively identify patients who may benefit from direct intensive care unit admission despite a lack of major severity criteria for community-acquired pneumonia based on the current guidelines.
Crit Care Med. 2009 Nov;37(11):2979-80.
Why do nice people get bad pneumonia? "Be quick or be dead" (Iron Maiden).
Luna CM, Sarquis S.
注：“Be Quick Or Be Dead”为铁娘子（Iron Maiden）合唱团的歌曲