Long-term outcome and health-related quality of life in difficult-to-wean patients with and without ventilator dependency at ICU discharge: a retrospective cohort study
Long-term outcome and health-related quality of life in difficult-to-wean patients with and without ventilator dependency at ICU discharge: a retrospective cohort study
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DOI：
10.1186/s12890-016-0295-0
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发表时间：
2016-09-27
影响因子：
3.1
通讯作者：
Derom, E.
中科院分区：
文献类型：
--
作者：
Depuydt, P.;Oeyen, S.;Derom, E.
背景：在 ICU 脱机失败后需要长时间机械通气的患者的长期结果和生活质量 (QOL) 几乎没有记录。我们的目的是评估因脱机困难而进行气管切开术从 ICU 出院的患者以及在 ICU 出院时有或没有呼吸机依赖的患者的长期生存和生活质量。方法：我们回顾性调查了 1999 年至 2013 年间入住三级中心内科 ICU 因脱机困难而需要气管切开术的患者的 ICU 后轨迹和生存情况，区分了依赖呼吸机或在 ICU 脱机的患者。 ICU 出院。 2014年，使用简表健康调查（SF-36）和严重呼吸功能不全问卷对幸存者进行了生活质量评估。结果：总共纳入了114名患者，其中59名依赖呼吸机，55名在ICU出院时脱离。一年生存率分别为 73% 和 69%。身体功能的总体生活质量评分较低，并且在 ICU 出院时进行通气的患者和撤机患者之间没有显着差异；两组的社会功能和心理健康评分均低于正常水平，且相似。结论：撤机失败后气管切开且依赖呼吸机从 ICU 出院的患者的长期生存率与气管切开并在 ICU 出院时撤机的患者的长期生存率没有显着差异。尽管两组的身体生活质量得分都很低，但心理生活质量是可以接受的。鉴于这项回顾性研究的内在局限性，需要进行前瞻性研究和优先多中心研究来证实这些初步结果。
Background: Long-term outcome and quality of life (QOL) in patients requiring prolonged mechanical ventilation after failure to wean in the ICU is scarcely documented. We aimed to evaluate long-term survival and QOL in patients discharged from the ICU with a tracheostomy for difficult weaning, and with or without ventilator dependency at ICU discharge.Methods: We retrospectively investigated post-ICU trajectories and survival in patients requiring tracheostomy for difficult weaning admitted to the medical ICU of a tertiary center between 1999 and 2013, discriminating between patients who were ventilator dependent or were weaned at ICU discharge. In 2014, a QOL assessment was done in survivors with the use of the Short Form Health Survey (SF-36) and the Severe Respiratory Insufficiency questionnaire.Results: A total of 114 patients was included, of whom 59 were ventilator dependent and 55 were weaned at ICU discharge. One-year survival rates were 73 % and 69 %, respectively. Overall QOL scores for physical functioning were low, and not significantly different between patients ventilated and those weaned at ICU discharge; scores for social functioning and mental health were less below norm and similar between both groups.Conclusions: Long-term survival in patients discharged from the ICU with tracheostomy and ventilator dependency after failure to wean was not significantly different from that of patients with tracheostomy and weaned at ICU discharge. Despite the physical QOL scores being low in both groups, mental QOL was acceptable. Given the intrinsic limitations of this retrospective study, prospective and preferentially multicenter studies are required to confirm these preliminary results.