The reality of patients requiring prolonged mechanical ventilation: a multicenter study.
The reality of patients requiring prolonged mechanical ventilation: a multicenter study.
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DOI：
10.5935/0103-507x.20150006
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发表时间：
2015-01
影响因子：
--
通讯作者：
Teixeira C
中科院分区：
文献类型：
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作者：
Loss SH;de Oliveira RP;Maccari JG;Savi A;Boniatti MM;Hetzel MP;Dallegrave DM;Balzano Pde C;Oliveira ES;Höher JA;Torelly AP;Teixeira C
在过去十年中，需要长时间机械通气的患者数量增加，这产生了大量的慢性病患者。本研究确定了4个重症监护病房延长机械通气的发生率，并报告了延长机械通气患者（机械通气依赖≥21天）与非延长机械通气患者（机械通气依赖< 21天）的不同特征、医院结局、成本和服务影响。本研究是一项多中心队列研究，纳入了4个重症监护病房的所有患者。主要结局指标为重症监护病房的住院时间、住院时间、重症监护病房住院期间的并发症、重症监护病房和住院死亡率。在研究期间，共有5287人入住重症监护病房。部分患者（41.5%）需要通气支持（n = 2197）， 218例患者符合延长机械通气标准（9.9%）。重症监护病房住院期间出现的一些并发症，如肌肉无力、压疮、细菌性院内败血症、念珠菌病、肺栓塞和过动性谵妄，与延长机械通气的风险显著增加相关。延长机械通气患者的重症监护病房死亡率（绝对差异= 14.2%,p < 0.001）和住院死亡率（绝对差异= 19.1%,p < 0.001）显著增加。延长机械通气组在重症监护病房出院后的住院天数更长（26.9±29.3天比10.3±20.4天，p < 0.001），且费用更高。根据本研究采用的延长机械通气的定义（机械通气依赖≥21天）对慢性危重症患者进行分类，确定重症监护期间并发症风险高、重症监护和住院时间长、死亡率高、费用高的患者。
The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ≥ 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency < 21 days). This study was a multicenter cohort study of all patients who were admitted to four intensive care units. The main outcome measures were length of stay in the intensive care unit, hospital, complications during intensive care unit stay, and intensive care unit and hospital mortality. There were 5,287 admissions to the intensive care units during study period. Some of these patients (41.5%) needed ventilatory support (n = 2,197), and 218 of the patients met criteria for prolonged mechanical ventilation (9.9%). Some complications developed during intensive care unit stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of prolonged mechanical ventilation. Prolonged mechanical ventilation patients had a significant increase in intensive care unit mortality (absolute difference = 14.2%, p < 0.001) and hospital mortality (absolute difference = 19.1%, p < 0.001). The prolonged mechanical ventilation group spent more days in the hospital after intensive care unit discharge (26.9 ± 29.3 versus 10.3 ± 20.4 days, p < 0.001) with higher costs. The classification of chronically critically ill patients according to the definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation dependency ≥ 21 days) identified patients with a high risk for complications during intensive care unit stay, longer intensive care unit and hospital stays, high death rates, and higher costs.