Báo cáo y học: Bench-to-bedside review: The MET syndrome – the challenges of researching and adopting medical emergency teams

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Bench-to-bedside review: The MET syndrome – the challenges of researching and adopting medical emergency teams...
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Báo cáo y học: "Bench-to-bedside review: The MET syndrome – the challenges of researching and adopting medical emergency teams" Available online http://ccforum.com/content/12/1/205ReviewBench-to-bedside review: The MET syndrome – the challenges ofresearching and adopting medical emergency teamsAugustine Tee, Paolo Calzavacca, Elisa Licari, Donna Goldsmith and Rinaldo BellomoDepartment of Intensive Care and Department of Surgery (Melbourne University), Austin Hospital, Studley Road, Heidelberg, Melbourne, Victoria 3084,AustraliaCorresponding author: Rinaldo Bellomo, rinaldo.bellomo@austin.org.auPublished: 23 January 2008 Critical Care 2008, 12:205 (doi:10.1186/cc6199)This article is online at http://ccforum.com/content/12/1/205© 2008 BioMed Central LtdAbstract adverse events, with an overall hospital mortality of 5% to 8% [1-3]. Importantly, an estimated 37% of these events may beStudies of hospital performance highlight the problem of ‘failure to preventable [3]. Multiple studies from Europe, the US, andrescue’ in acutely ill patients. This is a deficiency strongly Australia have also confirmed deficiencies in the wayassociated with serious adverse events, cardiac arrest, or death.Rapid response systems (RRSs) and their efferent arm, the hospitals and ‘traditional’ models of care respond to acutemedical emergency team (MET), provide early specialist critical illness in the wards [4-7]. One deficiency of the hospitalcare to patients affected by the ‘MET syndrome’: unequivocal system’s approach to acute illness is the problem of ‘failure tophysiological instability or significant hospital staff concern for rescue’ [8]: failure to deliver rapid and competent care to anpatients in a non-critical care environment. This intervention aims to acutely ill ward patient. Traditionally, hospitals have left suchprevent serious adverse events, cardiac arrests, and unexpected rapid responses to either the parent unit or cardiac arrestdeaths. Though clinically logical and relatively simple, its adoptionposes major challenges. Furthermore, research about the effective- teams. Unfortunately, the parent unit doctors are often unableness of RRS is difficult to conduct. Sceptics argue that inadequate to attend the patient rapidly or are not specifically or sufficientlyevidence exists to support its widespread application. Indeed, trained in acute resuscitation [4-7]. Although cardiac arrestsupportive evidence is based on before-and-after studies, obser- teams have been around for decades, they often arrive at thevational investigations, and inductive reasoning. However, imple- end of the disease cascade, are unsuccessful in greater thanmenting a complex intervention like RRS poses enormous logistic,political, cultural, and financial challenges. In addition, double- 85% of patients, and patients so treated may survive the arrestblinded randomised controlled trials of RRS are simply not but carry a high risk of hypoxic brain injury [9-11]. Thesepossible. Instead, as in the case of cardiac arrest and trauma observations suggest that earlier recognition of diseaseteams, change in practice may be slow and progressive, even in progression provides the opportunity to avert major adversethe absence of level I evidence. It appears likely that the events in many cases. In others, it provides the opportunity toaccumulation of evidence from different settings and situations, put in place a terminal care plan that prevents unnecessarythough methodologically imperfect, will increase the rationale andlogic of RRS. A conclusive randomised controlled trial is unlikely to interventions and an undign ...