Six-month survival of patients with acute lung injury: prospective cohort study.
Six-month survival of patients with acute lung injury: prospective cohort study.
复制标题
急性肺损伤患者的六个月生存率：前瞻性队列研究。
DOI：
10.1097/01.ccm.0000284505.96481.24
复制
发表时间：
2007
影响因子：
8.8
通讯作者：
Gajic,Ognjen
中科院分区：
文献类型：
--
作者：
Yilmaz,Murat;Iscimen,Remzi;Keegan,MarkT;Vlahakis,NicholasE;Afessa,Bekele;Hubmayr,RolfD;Gajic,Ognjen
目的：到目前为止，急性肺损伤(ALI)的短期和长期结果研究都是在实施机械通气和支持性护理的最新进展之前和/或在受限纳入标准的临床试验的背景下进行的。设计：前瞻性队列研究。设置：两家三级医院的三个重症监护室。患者：2005年10月至2006年5月收治的急性肺损伤患者，不包括那些没有研究授权或未实施复苏命令的患者。干预：无。测量和主要结果：调查人员收集关于合并症、肺和非肺器官衰竭的严重程度、并发症、呼吸支持和其他干预措施的详细信息。主要的预后指标是急性肺损伤发病6个月后的死亡率。在6个月期间登记的142名患者中，24名(17%)在重症监护室死亡，38名(27%)在医院死亡，55名(39%)在6个月随访结束时死亡。重症监护病房平均住院天数为7.1天(3.6-11.3天)，机械通气持续时间为5.7天(2.6-10.3天)，无呼吸机天数为19.0天(0-24.2天)。多元Logistic回归分析确定了每增加一分、从楼层或医院外转院入院(优势比3.75，95%可信区间1.41-10.99)、第三天心血管衰竭(优势比3.30，95%可信区间1.19-9.92)和第三天PaO2/FiO2(优势比0.94)的潜在Charlson共病评分(优势比3.11，95%可信区间2.01-5.05)。95%可信区间0.88-0.99)作为6个月死亡率的显著预测因素。结论：随着机械通气和支持性护理的最新进展的实施，病前状态是急性肺损伤存活的最重要的决定因素。
Objective:Both short-and long-term outcome studies in acute lung injury (ALI) performed thus far were conducted before the implementation of recent advances in mechanical ventilation and supportive care and/or in the context of clinical trials with restricted inclusion criteria. We sought to determine the outcome of consecutive acute lung injury patients after the implementation of these interventions.Design:Prospective cohort study.Setting:Three intensive care units of two tertiary care hospitals.Patients:Patients with acute lung injury treated from October 2005 to May 2006, excluding those with no research authorization or do-not-resuscitate order.Interventions:None.Measurements and Main Results:The investigators collected detailed information about comorbidities, severity of pulmonary and nonpulmonary organ failures, complications, respiratory support, and other interventions. The main outcome measure was mortality 6 months after the onset of acute lung injury. From 142 patients enrolled over a 6-month period, 24 (17%) died in the intensive care unit, 38 (27%) in the hospital, and 55 (39%) by the end of the 6-month follow-up. Median (interquartile range) intensive care unit length of stay, duration of mechanical ventilation, and number of day 28 ventilator-free days were 7.1 (3.6–11.3), 5.7 (2.6–10.3), and, 19.0 (0–24.2) days. Multiple logistic regression analysis identified underlying Charlson comorbidity score (odds ratio 3.11, 95% confidence interval 2.01–5.05) for each point increase, transfer admission from the floor or outside hospital (odds ratio 3.75, 95% confidence interval 1.41–10.99), day 3 cardiovascular failure (odds ratio 3.30, 95% confidence interval 1.19–9.92), and day 3 Pao 2/Fio 2 (odds ratio 0.94, 95% confidence interval 0.88–0.99) as significant predictors of 6-month mortality.Conclusions:With the implementation of recent advances in mechanical ventilation and supportive care, premorbid condition is the most important determinant of acute lung injury survival.