Gastrostomy Tube Use in the Critically III, 1994-2014
Gastrostomy Tube Use in the Critically III, 1994-2014
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DOI：
10.1513/annalsats.201809-638oc
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发表时间：
2019-06-01
影响因子：
8.3
通讯作者：
Walkey, Allan J.
中科院分区：
文献类型：
--
作者：
Law, Anica C.;Stevens, Jennifer P.;Walkey, Allan J.
理由：尽管胃造口管对晚期痴呆患者的益处有限，但它们仍被用于危重患者的营养支持。流行病学和短期结果尚不清楚。目的：量化过去二十年来美国危重病人胃造口管置入的国家实践模式和短期结果。方法：利用美国卫生与研究质量署医疗成本与利用项目的全国住院患者样本，评估1994 - 2014年危重症成人胃造口管放置年度人口标准化率的变化趋势；我们还量化了住院时间、住院死亡率和出院地点的趋势。我们对机械通气患者、幸存者和危重患者的死者以及排除痴呆患者的危重患者人群进行了敏感性分析。结果：从1994年到2014年，危重患者胃造口管的人群发生率从每10万美国成年人11.9例增加到28.8例（发生率在2010年达到高峰），增加了142%（危重患者胃造口管31,392-91,990例，P < 0.001）。危重期接受胃造瘘管的患者在所有胃造瘘管放置中所占的比例越来越大，1994年为19.6%，2014年为50.8%。危重患者的胃造口率基本保持稳定，从1994年的2.5%降至2002年的峰值3.7%，然后再次下降至2014年的2.4%。胃造口管受术者住院时间和住院死亡率下降（分别为28.7 d至20.5 d, P < 0.001; 25.9 11.3%, P < 0.001），而长期设施的出院率显著增加（49.6-70.6%,P < 0.001）。机械通气患者的敏感性分析显示，基于人群的胃造口管置入估计也有类似的增加。结论：1994 - 2014年危重患者胃造口管置入率增加了一倍以上，多数患者出院后转入长期护理机构。在美国，危重病人现在是胃造口管的主要使用者。需要进一步的研究来更好地描述在危重患者中使用胃造口管的长期风险和益处。
Rationale: Although gastrostomy tubes have shown to be of limited benefit in patients with advanced dementia, they continue to be used to deliver nutritional support in critically ill patients. The epidemiology and short-term outcomes are unclear.Objectives: To quantify national practice patterns and short-term outcomes of gastrostomy tube placement among the critically ill over the last two decades in the United States.Methods: Using the U.S. Agency for Healthcare and Research Quality's Healthcare Cost and Utilization Project's National Inpatient Sample, we evaluated trends in annual population-standardized rates of gastrostomy tube placement among critically ill adults from 1994 to 2014; we also quantified trends in length of stay, in-hospital mortality, and discharge location. We conducted sensitivity analyses among mechanically ventilated patients, survivors, and decedents of critical illness, and in a critically ill population excluding patients with dementia.Results: From 1994 to 2014, population-based rates of gastrostomy tube use in critically ill patients increased from 11.9 to 28.8 gastrostomies per 100,000 U.S. adults (peak in incidence in 2010), an increase of 142% (31,392-91,990 gastrostomy tubes in critically ill patients; P < 0.001). Patients receiving gastrostomy tubes during critical illness occupied a growing proportion of all gastrostomy tube placements, accounting for 19.6% of all gastrostomy tubes placed in 1994 and 50.8% in 2014. The rate of gastrostomies in critically ill patients remained roughly stable, from 2.5% of critically ill patients in 1994 to a peak of 3.7% in 2002 before declining again to 2.4% in 2014. Hospital length of stay and in-hospital mortality decreased among gastrostomy tube recipients (28.7 d to 20.5 d, P < 0.001; 25.9 11.3%, P < 0.001; respectively), whereas discharges to long-term facilities increased significantly (49.6-70.6%; P < 0.001). Sensitivity analyses among mechanically ventilated patients revealed similar increases in population-based estimates of gastrostomy tube placement.Conclusions: The incidence of gastrostomy tube placement among critically ill patients more than doubled between 1994 and 2014, with most patients being discharged to long-term care facilities. Critically ill patients are now the primary utilizer of gastrostomy tubes placed in the United States. Additional research is needed to better characterize the long-term risk and benefits of gastrostomy tube use in critically ill patients.