부산대학교 도서관

Background: A predictive model that uses the rhythmicity of core body temperature (CBT) could be an easily accessible clinical tool to ultimately improve outcomes among critically ill patients. Objectives: To assess the relation between the 24-hour CBT profile (CBT-24) before intensive care unit (ICU) discharge and clinical events in the step-down unit within 7 days of ICU discharge. Methods: This retrospective cohort study in a tertiary ICU at a single center included adult patients requiring acute invasive ventilation for more than 48 hours and assessed major clinical adverse events (MCAEs) and rapid response system activations (RRSAs) within 7 days of ICU discharge (MCAE-7 and RRSA-7, respectively). Results: The 291 enrolled patients had a median mechanical ventilation duration of 139 hours (IQR, 50-862 hours) and at admission had a median Acute Physiology and Chronic Health Evaluation II score of 22 (IQR, 7-42). At least 1 MCAE or RRSA occurred in 64% and 22% of patients, respectively. Independent predictors of an MCAE-7 were absence of CBT-24 rhythmicity (odds ratio, 1.78 [95% CI, 1.07-2.98]; P =.03), Sequential Organ Failure Assessment score at ICU discharge (1.10 [1.00-1.21]; P =.05), male sex (1.72 [1.04-2.86]; P =.04), age (1.02 [1.00-1.04]; P =.02), and Charlson Comorbidity Index (0.87 [0.76-0.99]; P =.03). Age (1.03 [1.01-1.05]; P =.006), sepsis at ICU admission (2.02 [1.13-3.63]; P =.02), and Charlson Comorbidity Index (1.18 [1.02-1.36]; P =.02) were independent predictors of an RRSA-7. Conclusions: Use of CBT-24 rhythmicity can assist in stratifying a patient's risk of subsequent deterioration during general care within 7 days of ICU discharge.