Epidemiological trends in invasive mechanical ventilation in the United States: A population-based study
Epidemiological trends in invasive mechanical ventilation in the United States: A population-based study
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DOI：
10.1016/j.jcrc.2015.07.007
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发表时间：
2015-12-01
影响因子：
3.7
通讯作者：
Walkey, Allan J.
中科院分区：
文献类型：
--
作者：
Mehta, Anuj B.;Syeda, Sohera N.;Walkey, Allan J.
目的：有创机械通气（IMV）的流行病学趋势尚未明确定义。我们试图确定IMV在美国的趋势，并评估3种常见呼吸衰竭原因的疾病特异性变化：肺炎、心力衰竭（HF）和慢性阻塞性肺疾病（COPD）。方法：我们计算了1993年至2009年全国住院患者样本中非手术IMV病例利用率的全国估计值，并比较了COPD、HF和肺炎的趋势。我们确定了8309344例IMV从1993年至2009年。IMV用于非手术适应症的使用率从1993年的178.9/10万增加到2009年的310.9/10万。需要IMV的肺炎病例增加最多（103.6%），而COPD病例保持相对稳定（增加2.5%），HF病例减少55.4%。在肺炎、COPD和HF中观察到了类似的人口统计学和临床变化，IMV病例变得更年轻，种族更多样化，并且更频繁地由医疗补助保险。患者的结局趋势因诊断而异。肺炎病例的调整后住院死亡率随时间推移而下降（每5年的比值比[OR]，0.89; 95%置信区间[CI]，0.88-0.90）和COPD（OR每5年，0.97; 95% CI，0.97-0.98），但HF增加（OR每5年，1.10; 95%CI，1.09-1.12）。结论：1993年至2009年，美国IMV的使用增加，总体死亡率下降。然而，IMV的使用和结果的趋势在诊断的基础上明显不同。与肺炎和COPD的有利结局趋势不同，HF的住院死亡率并未改善。需要进一步研究HF和其他呼吸衰竭原因之间的结果差异。(C)2015 Elsevier Inc. All rights reserved.
Purpose: Epidemiological trends for invasive mechanical ventilation (IMV) have not been clearly defined. We sought to define trends for IMV in the United States and assess for disease-specific variation for 3 common causes of respiratory failure: pneumonia, heart failure (HF), and chronic obstructive pulmonary disease (COPD).Methods: We calculated national estimates for utilization of nonsurgical IMV cases from the Nationwide Inpatient Sample from 1993 to 2009 and compared trends for COPD, HF, and pneumonia.Results: We identified 8309344 cases of IMV from 1993 to 2009. Utilization of IMV for nonsurgical indications increased from 178.9 per 100000 in 1993 to 310.9 per 100000 US adults in 2009. Pneumonia cases requiring IMV showed the largest increase (103.6%), whereas COPD cases remained relatively stable (2.5% increase) and HF cases decreased by 55.4%. Similar demographic and clinical changes were observed for pneumonia, COPD, and HF, with cases of IMV becoming younger, more ethnically diverse, and more frequently insured by Medicaid. Outcome trends for patients differed based on diagnosis. Adjusted hospital mortality decreased over time for cases of pneumonia (odds ratio [OR] per 5 years, 0.89; 95% confidence interval [CI], 0.88-0.90) and COPD (OR per 5 years, 0.97; 95% CI, 0.97-0.98) but increased for HF (OR per 5 years, 1.10; 95% CI, 1.09-1.12).Conclusion: Utilization of IMV in the US increased from 1993 to 2009 with a decrease in overall mortality. However, trends in utilization and outcomes of IMV differed markedly based on diagnosis. Unlike favorable outcome trends in pneumonia and COPD, hospital mortality for HF has not improved. Further studies to investigate the outcome gap between HF and other causes of respiratory failure are needed. (C) 2015 Elsevier Inc. All rights reserved.