{"id":26992,"date":"2024-10-15T04:54:00","date_gmt":"2024-10-14T20:54:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=26992"},"modified":"2024-10-15T05:39:52","modified_gmt":"2024-10-14T21:39:52","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e8%bf%9c%e7%a8%8bicu%e5%af%b9%e9%87%8d%e7%97%87%e6%82%a3%e8%80%85%e4%b8%b4%e5%ba%8a%e9%a2%84%e5%90%8e%e7%9a%84%e5%bd%b1%e5%93%8d","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=26992","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u8fdc\u7a0bICU\u5bf9\u91cd\u75c7\u60a3\u8005\u4e34\u5e8a\u9884\u540e\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Original Investigation\u00a0| Caring for the Critically Ill Patient<\/p>\n\n\n\n

October 9, 2024<\/p>\n\n\n\n

Effect of Tele-ICU on Clinical Outcomes of Critically Ill Patients: The TELESCOPE Randomized Clinical Trial<\/h1>\n\n\n\n

Adriano J.\u00a0Pereira,\u00a0Danilo T.\u00a0Noritomi,\u00a0Maura Cristina\u00a0dos Santos,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online October 9, 2024. doi:10.1001\/jama.2024.20651<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Is an intensivist-led telemedicine-based strategy including daily multidisciplinary rounds combined with monthly audit and feedback able to reduce intensive care unit (ICU) length of stay compared with usual care?<\/p>\n\n\n\n

Findings<\/strong>  In a cluster randomized clinical trial of 30 ICUs (n\u2009=\u200915\u202f230 patients in the intervention period), multidisciplinary rounds and monthly audit and feedback meetings performed by remote intensivists (tele-ICU) did not significantly reduce the ICU length of stay compared with the standard care group.<\/p>\n\n\n\n

Meaning<\/strong>  An intervention comprising daily multidisciplinary rounds and monthly audit and feedback meetings performed by board-certified remote intensivists (tele-ICU) had no impact on ICU length of stay.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Despite its implementation in several countries, there has not been a randomized clinical trial to assess whether telemedicine in intensive care units (ICUs) could improve clinical outcomes of critically ill patients.<\/p>\n\n\n\n

Objective<\/strong>  To determine whether an intervention comprising daily multidisciplinary rounds and monthly audit and feedback meetings performed by a remote board-certified intensivist reduces ICU length of stay (LOS) compared with usual care.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  A parallel cluster randomized clinical trial with a baseline period in 30 general ICUs in Brazil in which daily multidisciplinary rounds performed by board-certified intensivists were not routinely available. All consecutive adult patients (aged \u226518 years) admitted to the participating ICUs, excluding those admitted due to justice-related issues, were enrolled between June 1, 2019, and April 7, 2021, with last follow-up on July 6, 2021.<\/p>\n\n\n\n

Intervention<\/strong>  Remote daily multidisciplinary rounds led by a board-certified intensivist through telemedicine, monthly audit and feedback meetings for discussion of ICU performance indicators, and provision of evidence-based clinical protocols.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was ICU LOS at the patient level. Secondary outcomes included ICU efficiency, in-hospital mortality, incidence of central line\u2013associated bloodstream infections, ventilator-associated events, catheter-associated urinary tract infections, ventilator-free days at 28 days, patient-days receiving oral or enteral feeding, patient-days under light sedation, and rate of patients with oxygen saturation values under that of normoxemia, assessed using generalized linear mixed models.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among 17\u202f024 patients (1794 in the baseline period and 15\u202f230 in the intervention period), the mean (SD) age was 61 (18) years, 44.7% were female, the median (IQR) Sequential Organ Failure Assessment score was 6 (2-9), and 45.5% were invasively mechanically ventilated at admission. The median (IQR) time under intervention was 20 (16-21) months. Mean (SD) ICU LOS, adjusted for baseline assessment, did not differ significantly between the tele\u2013critical care and usual care groups (8.1 [10.0] and 7.1 [9.0] days; percentage change, 8.2% [95% CI, \u22125.4% to 23.8%];\u00a0P<\/em>\u2009=\u2009.24). Results were similar in sensitivity analyses and prespecified subgroups. There were no statistically significant differences in any other secondary or exploratory outcomes.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Daily multidisciplinary rounds conducted by a board-certified intensivist through telemedicine did not reduce ICU LOS in critically ill adult patients.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT03920501<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation\u00a0| Caring for the Critically Ill […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26992"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26992"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26992\/revisions"}],"predecessor-version":[{"id":26993,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26992\/revisions\/26993"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26992"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26992"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26992"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}