综合用药管理对危重病人死亡率的影响。

IF 6 1区 医学 Q1 CRITICAL CARE MEDICINE
Andrea Sikora, Wanyi Min, John W Devlin, Mengxuan Hu, David J Murphy, Brian Murray, Bokai Zhao, Ye Shen, Xianyan Chen, Susan E Smith, Sandra Rowe, Tianming Liu, Sheng Li
{"title":"综合用药管理对危重病人死亡率的影响。","authors":"Andrea Sikora, Wanyi Min, John W Devlin, Mengxuan Hu, David J Murphy, Brian Murray, Bokai Zhao, Ye Shen, Xianyan Chen, Susan E Smith, Sandra Rowe, Tianming Liu, Sheng Li","doi":"10.1097/CCM.0000000000006802","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Medication management in the ICU is causally linked to both treatment success and adverse drug events. The purpose of this evaluation was to explore the effect of comprehensive medication management (CMM) on mortality in critically ill patients.</p><p><strong>Design: </strong>Retrospective, observational, propensity-matched cohort study.</p><p><strong>Setting: </strong>Adult ICUs at the Oregon Health Sciences University.</p><p><strong>Patients: </strong>Consecutive adults admitted to an ICU greater than or equal to 24 hours between June 1, 2020, and June 7, 2023, with available pharmacist intervention data.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>CMM was measured by documented critical care pharmacist (CCP) medication interventions. Propensity score matching was performed to generate a balanced 1:1 matched cohort, and logistic regression was applied for estimating propensity scores. The primary outcome was the odds of hospital mortality. Hospital and ICU length of stay were also assessed. In a cohort of 10,441 ICU patients, the unadjusted mortality rate was 11% with a mean Acute Physiology and Chronic Health Evaluation II score of 9.54 ± 4.18 and Medication Regimen Complexity-ICU (MRC-ICU) score of 5.78 ± 4.09. Compared with CCP interventions less than 3, more CCP interventions was associated with a significantly reduced risk of mortality (estimate, -0.04; 95% CI, -0.06 to -0.03; p < 0.01) and shorter length of ICU stay (estimate, -2.77; 95% CI, -2.98 to -2.56; p < 0.01).</p><p><strong>Conclusions: </strong>The quantity of CCP-delivered CMM in the ICU is directly associated with reduced hospital mortality independent of patient characteristics and MRC.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effect of Comprehensive Medication Management on Mortality in Critically Ill Patients.\",\"authors\":\"Andrea Sikora, Wanyi Min, John W Devlin, Mengxuan Hu, David J Murphy, Brian Murray, Bokai Zhao, Ye Shen, Xianyan Chen, Susan E Smith, Sandra Rowe, Tianming Liu, Sheng Li\",\"doi\":\"10.1097/CCM.0000000000006802\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Medication management in the ICU is causally linked to both treatment success and adverse drug events. The purpose of this evaluation was to explore the effect of comprehensive medication management (CMM) on mortality in critically ill patients.</p><p><strong>Design: </strong>Retrospective, observational, propensity-matched cohort study.</p><p><strong>Setting: </strong>Adult ICUs at the Oregon Health Sciences University.</p><p><strong>Patients: </strong>Consecutive adults admitted to an ICU greater than or equal to 24 hours between June 1, 2020, and June 7, 2023, with available pharmacist intervention data.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>CMM was measured by documented critical care pharmacist (CCP) medication interventions. Propensity score matching was performed to generate a balanced 1:1 matched cohort, and logistic regression was applied for estimating propensity scores. The primary outcome was the odds of hospital mortality. Hospital and ICU length of stay were also assessed. In a cohort of 10,441 ICU patients, the unadjusted mortality rate was 11% with a mean Acute Physiology and Chronic Health Evaluation II score of 9.54 ± 4.18 and Medication Regimen Complexity-ICU (MRC-ICU) score of 5.78 ± 4.09. Compared with CCP interventions less than 3, more CCP interventions was associated with a significantly reduced risk of mortality (estimate, -0.04; 95% CI, -0.06 to -0.03; p < 0.01) and shorter length of ICU stay (estimate, -2.77; 95% CI, -2.98 to -2.56; p < 0.01).</p><p><strong>Conclusions: </strong>The quantity of CCP-delivered CMM in the ICU is directly associated with reduced hospital mortality independent of patient characteristics and MRC.</p>\",\"PeriodicalId\":10765,\"journal\":{\"name\":\"Critical Care Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":6.0000,\"publicationDate\":\"2025-08-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/CCM.0000000000006802\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/CCM.0000000000006802","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0

摘要

目的:ICU的用药管理与治疗成功和药物不良事件有因果关系。本研究旨在探讨综合用药管理(CMM)对危重病人死亡率的影响。设计:回顾性、观察性、倾向匹配的队列研究。环境:俄勒冈健康科学大学的成人icu。患者:2020年6月1日至2023年6月7日期间在ICU连续住院24小时以上的成年人,并有可用的药剂师干预数据。干预措施:没有。测量方法和主要结果:CMM通过记录的重症监护药师(CCP)药物干预来测量。倾向得分匹配生成平衡的1:1匹配队列,并应用逻辑回归估计倾向得分。主要结果是住院死亡率。还评估了住院和ICU的住院时间。在10,441例ICU患者队列中,未经调整的死亡率为11%,急性生理和慢性健康评估II平均评分为9.54±4.18,药物治疗方案复杂性-ICU (MRC-ICU)评分为5.78±4.09。与少于3次的CCP干预相比,更多的CCP干预与死亡风险显著降低相关(估计值为-0.04;95% CI, -0.06 ~ -0.03;p < 0.01), ICU住院时间较短(估计为-2.77;95% CI, -2.98 ~ -2.56;P < 0.01)。结论:ICU中ccp输送的CMM数量与降低医院死亡率直接相关,与患者特征和MRC无关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of Comprehensive Medication Management on Mortality in Critically Ill Patients.

Objectives: Medication management in the ICU is causally linked to both treatment success and adverse drug events. The purpose of this evaluation was to explore the effect of comprehensive medication management (CMM) on mortality in critically ill patients.

Design: Retrospective, observational, propensity-matched cohort study.

Setting: Adult ICUs at the Oregon Health Sciences University.

Patients: Consecutive adults admitted to an ICU greater than or equal to 24 hours between June 1, 2020, and June 7, 2023, with available pharmacist intervention data.

Interventions: None.

Measurements and main results: CMM was measured by documented critical care pharmacist (CCP) medication interventions. Propensity score matching was performed to generate a balanced 1:1 matched cohort, and logistic regression was applied for estimating propensity scores. The primary outcome was the odds of hospital mortality. Hospital and ICU length of stay were also assessed. In a cohort of 10,441 ICU patients, the unadjusted mortality rate was 11% with a mean Acute Physiology and Chronic Health Evaluation II score of 9.54 ± 4.18 and Medication Regimen Complexity-ICU (MRC-ICU) score of 5.78 ± 4.09. Compared with CCP interventions less than 3, more CCP interventions was associated with a significantly reduced risk of mortality (estimate, -0.04; 95% CI, -0.06 to -0.03; p < 0.01) and shorter length of ICU stay (estimate, -2.77; 95% CI, -2.98 to -2.56; p < 0.01).

Conclusions: The quantity of CCP-delivered CMM in the ICU is directly associated with reduced hospital mortality independent of patient characteristics and MRC.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Critical Care Medicine
Critical Care Medicine 医学-危重病医学
CiteScore
16.30
自引率
5.70%
发文量
728
审稿时长
2 months
期刊介绍: Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信