Is the duration of mechanical ventilation predictable?
Is the duration of mechanical ventilation predictable?
复制标题
机械通气的持续时间可以预测吗？
作者：
G. Troché;P. Moine
背景
长期机械通气（MV）与高发病率、死亡率和成本相关。然而，很少和有限的数据可用于预测MV的持续时间。我们进行了一项观察性队列研究，以寻求预测标准。
方法
该研究在一所大学医院的外科ICU（SICU）进行。前瞻性分析了195例连续性二尖瓣返流患者和203次二尖瓣返流，以确定入院或插管时的临床特征、生理参数或多因素评分系统是否可用作二尖瓣≥ 15天的预测因素。采用单因素统计分析和多元Logistic回归分析。然后进行了前瞻性验证研究以确定结果的准确性。
结果
(1)单变量统计分析表明，SICU住院时间、紧急气管插管（与择期插管相比）、MV适应证、入院和插管时脓毒症评分、入院和插管时肺损伤评分（LIS）、入院和插管时器官系统衰竭数量以及血清白蛋白浓度在两组之间存在显著差异。(2)只有气管插管的情况（紧急情况）（比值比[OR]=3.5，p=0.02）和LIS（OR=3.7，p=0.004）独立预测气管插管的持续时间>或= 15天。前瞻性验证包括128名需要紧急插管和MV的连续患者。LIS >或= 1用于预测MV >或= 15天的准确性如下：敏感性=0.88;特异性=0.28;阳性预测值=0.24;阴性预测值=0.91。
结论
在ICU患者中观察到MV ≥ 15天的发生率较低（在观察性队列研究和验证研究中分别为13%和20%）。插管时LIS >或= 1提供了MV持续时间>或= 15天的极好阴性预测值（0.93和0.91）。这些数据表明，对于LIS < 1的患者，不应考虑气管切开术。
BACKGROUND
Prolonged mechanical ventilation (MV) is associated with high morbidity, mortality, and cost. However, few and limited data are available on the prediction of duration of MV. We conducted an observational cohort study to seek predictive criteria.
METHODS
The study was performed in a surgical ICU (SICU) in a university hospital. One hundred ninety-five consecutive unselected patients and 203 episodes of MV were prospectively analyzed to determine if clinical features, physiologic parameters, or multifactor scoring systems, at the time of admission or intubation, could be used as predictors of MV > or = 15 days. A univariate statistical analysis and a multiple logistic regression were used. A prospective validation study was then conducted to determine the accuracy of the results.
RESULTS
(1) Univariate statistical analysis indicated that SICU length of stay, emergent endotracheal intubation as opposed to elective intubation, indication for MV, sepsis score at the time of admission and intubation, lung injury score (LIS) at the time of admission and intubation, number of organ system failures at the time of admission and intubation, and serum albumin concentration were significantly different between the two groups. (2) Only the circumstances (emergency) of endotracheal intubation (odds ratio [OR]=3.5, p=0.02) and the LIS (OR=3.7, p=0.004) independently predicted a duration of endotracheal intubation > or = 15 days. One hundred twenty-eight consecutive patients requiring emergent intubation and MV were included in the prospective validation. The accuracy of the LIS > or = 1 used to predict MV > or = 15 days was as follows: sensitivity=0.88; specificity=0.28; positive predictive value=0.24; negative predictive value=0.91.
CONCLUSION
Low incidence of MV > or = 15 days was observed (13% and 20%, respectively, in observational cohort study and validation study) in unselected SICU patients. LIS > or = 1 at the time of intubation provides excellent negative predictive value (0.93 and 0.91) of duration of MV > or = 15 days. These data suggest that tracheotomy should not be considered for patients with LIS < 1.