Assessment of prognosis in patients with community-acquired pneumonia who require mechanical ventilation
Assessment of prognosis in patients with community-acquired pneumonia who require mechanical ventilation
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DOI：
10.1378/chest.117.2.503
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发表时间：
2000-02-01
期刊：
影响因子：
9.6
通讯作者：
Wachter, RM
中科院分区：
文献类型：
--
作者：
Pascual, FE;Matthay, MA;Wachter, RM
研究目的：了解到需要机械通气的社区获得性肺炎（CAP）患者的死亡率很高，我们假设急性肺损伤的严重程度可以沿着非肺部因素来识别死亡风险最高的患者。我们制定了一个预测模型，以定量的医院死亡率的风险，在这一人群的患者，设计：历史前瞻性研究，使用收集的数据在第一个24小时的机械通气。我们使用了低氧血症指数-（1 -最低[Pao（2）/PAo（2））x（维持Pao（2）在> 60 mm Hg的吸入氧气的最小分数）× 100]，其中Pao（2）是肺泡氧分压-以在从0到100的量表上对急性肺损伤的严重程度进行分级。144例因CAP引起的呼吸衰竭而接受机械通气的成人患者。测量和结果：住院死亡率为46%（n = 66）。多因素Logistic回归分析显示了5个独立的住院死亡预测因素：（1）低氧血症指数评估的肺损伤程度;（2）非肺器官衰竭的数量;（3）免疫抑制;（4）年龄> 80岁;和（5）预后存活< 5年的医学合并症，在50%死亡率阈值下，预测模型在88%的病例中正确分类了结果。所有患者死亡的预测概率> 95%，死于hospital.Conclusions：根据临床参数测量的第一个24小时的机械，通气，该模型准确地确定了危重，机械通气患者与CAP的长期重症监护可能没有好处。
Study objectives: Knowing that mortality is high in patients who require mechanical ventilation patients with community-acquired pneumonia (CAP), we hypothesized that the severity of acute lung injury could be used along with nonpulmonary factors to identify patients with the highest risk of death. We formulated a prediction model to quantitate the risk of hospital mortality in this population of patients,Design: Historical prospective study using data collected over the first 24 h of mechanical ventilation. We utilized a hypoxemia index-(1 - lowest [Pao(2)/PAo(2)) x (minimum fraction of inspired oxygen to maintain Pao(2) at > 60 mm Hg) x 100], where PAo(2) is the alveolar partial pressure of oxygen-to grade the severity of acute lung injury on a scale from 0 to 100.Setting: Tertiary care university hospital ICU.Patients: One hundred forty-four adult patients mechanically ventilated for respiratory failure caused by CAP.Measurements and results: Hospital mortality was 46% (n = 66). Multivariate logistic regression analysis revealed five independent predictors of hospital mortality: (1) the extent of lung injury assessed by the hypoxemia index; (2) the number of nonpulmonary organs that failed; (3) immunosuppression; (4) age > 80 years; and (5) medical comorbidity with a prognosis for survival < 5 years, At a 50% mortality threshold, the prediction model correctly classified outcome in 88% of cases. All patients with > 95% predicted probability of death died in hospital.Conclusions: Based on clinical parameters measured over the first 24 h of mechanical, ventilation, this model accurately identified critically ill, mechanically ventilated patients with CAP for whom prolonged intensive care may not be of benefit.