Анестезия и клинические исследования
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Impact of Intensive Care Unit Physician on Care Processes of Patients with Severe Sepsis in Teaching Hospitals

Takeshi Umegaki, Miho Sekimoto and Yuichi Imanaka

Objective: The purpose of the study was to investigate associations among intensive care unit (ICU) staffing and care processes in patients with severe sepsis.

Design: An observational multicenter cross-sectional study performed from October 2007 to March 2008.

Setting: Forty-nine teaching hospitals in Japan.

 Participants: Patients (n=576) with severe sepsis identified using ICD-10 codes from administrative data.

Main outcome measures: Care processes including mechanical ventilation, dialysis, enteral feeding, parentetal nutrition, and antibiotic empirical therapy which were available in administrative data.

Results: ICUs were classified as high- or low-intensity based on policies regarding the responsibilities of intensivists. There were no differences in baseline patient characteristics between the ICU groups. In the high-intensity group, ICU stay for survivors was about two days shorter and hospital stay was significantly shorter by three days. Majority of patients had high rates of enteral feeding; however, the high-intensity group had significantly earlier initiation of enteral feeding and a significantly shorter duration of mechanical ventilation. A shorter duration of mechanical ventilation was significantly associated with the ICU structure.

Conclusions: The results showed an association between ICU physician and processes of intensive care, and high-intensity ICU was aggressive in mechanical ventilation in patients with severe sepsis.