Post-ICU mechanical ventilation at 23 long-term care hospitals - A multicenter outcomes study
Post-ICU mechanical ventilation at 23 long-term care hospitals - A multicenter outcomes study
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DOI：
10.1378/chest.06-1081
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发表时间：
2007-01-01
期刊：
影响因子：
9.6
通讯作者：
Petrak, Richard A.
中科院分区：
文献类型：
--
作者：
Scheinhorn, David J.;Hassenpflug, Meg Stearn;Petrak, Richard A.
研究目的：本多中心研究的特点是呼吸机依赖患者的长期护理医院（LTCHs）与脱机程序，并报告治疗，并发症，脱机结果，出院处置，并在这些patients.Design生存的人口：观察性研究，同时收集数据。患者：从2002年3月1日至2003年2月28日，共收集了1,419例呼吸机依赖患者。患者的中位年龄为71.8岁（范围：18 - 97.7岁）。患者在LTCH住院期间平均接受6.9次手术和治疗;中位住院时间为40天（范围：1 - 365天）。在LTCH治疗的10种最常见并发症中有7种是感染;充血性心力衰竭和糖尿病是最常见的需要治疗的合并症。在LTCH出院时评分的脱机尝试结局为54.1%脱机，20.9%依赖呼吸机，25.0%死亡。中位断奶时间（n = 766）为15天（范围：7 - 30天）。出院处置包括28.8%回家，49.2%到康复和扩展护理机构，19.5%到短期急性医院。近三分之一的患者被认为是活着的12个月后入院LTCH.Conclusions：患者承认LTCHs断奶尝试是老年人，急性慢性疾病，并继续需要相当大的医疗干预和治疗。在长期和积极的ICU干预后，并发症的频率和类型并不奇怪。在重症监护医学的连续性中，超过一半的从ICU转移的灾难性疾病的呼吸机依赖幸存者在LTCH环境中成功脱离了长期机械通气。
Study objectives: This multicenter study was undertaken to characterize the population of ventilator-dependent patients admitted to long-term care hospitals (LTCHs) with weaning programs, and to report treatments, complications, weaning outcome, discharge disposition, and survival in these patients.Design: Observational study with concurrent data collection.Setting: Twenty-three LTCHs in the United States. Patients: Consecutive ventilator-dependent patients admitted over a 1-year period: March 1, 2002, to February 28, 2003.Results: A total of 1,419 patients were enrolled in the Ventilation Outcomes Study. Median age of patients was 71.8 years (range, 18 to 97.7 years). Patients averaged 6.9 procedures and treatments during the LTCH hospitalization; median length of stay was 40 days (range, I to 365 days). Seven of the 10 most frequent complications treated at the LTCH were infections; congestive heart failure and diabetes mellitus were the most common comorbidities requiring treatment. Outcomes of weaning attempts, scored at LTCH discharge, were 54.1% weaned, 20.9% ventilator dependent, and 25.0% deceased. Median time to wean (n = 766) was 15 days (range, 7 to 30 days). Discharge disposition included 28.8% to home, 49.2% to rehabilitation and extended-care facilities, and 19.5% to short-stay acute hospitals. Nearly one third of patients were known to be alive 12 months after admission to the LTCH.Conclusions: Patients admitted to LTCHs for weaning attempts were elderly, with acute-on-chronic diseases, and continued to require considerable medical interventions and treatments. The frequency and type of complications were not surprising following prolonged and aggressive ICU interventions. In the continuum of critical care medicine, more than half of ventilator-dependent survivors of catastrophic illness transferred from the ICU were successfully weaned from prolonged mechanical ventilation in the setting of an LTCH.