One-Year Functional Outcomes After Invasive Mechanical Ventilation for Older Adults With Preexisting Long-Term Care-Needs*
One-Year Functional Outcomes After Invasive Mechanical Ventilation for Older Adults With Preexisting Long-Term Care-Needs*
复制标题
已有长期护理需求的老年人接受有创机械通气后一年的功能结果*
DOI：
10.1097/ccm.0000000000005822
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发表时间：
2023
影响因子：
8.8
通讯作者：
Sasabuchi Yusuke
中科院分区：
文献类型：
--
作者：
Ohbe Hiroyuki;Ouchi Kei;Miyamoto Yuki;Ishigami Yuichiro;Matsui Hiroki;Yasunaga Hideo;Sasabuchi Yusuke
目的：研究大于或等于65岁且既往存在长期护理需求的成人有创机械通气后1年的功能结局。设计：我们使用医疗和长期护理管理数据库。该数据库包括功能和认知障碍的数据，这些数据是通过国家标准化护理需求认证系统评估的，并根据每日估计护理总时间分为七个护理需求级别。主要结局是有创机械通气后1年的死亡率和护理需求。结果根据有创机械通气时已有的护理需要进行分层：无护理需要、支持1 - 2级和护理需要1级（估计护理时间25-49分钟）、护理需要2-3级（50-89分钟）和护理需要4-5级（≥90分钟）。背景：在日本47个县之一的枥木县进行的一项基于人群的队列研究。患者：在2014年6月至2018年2月期间登记的大于或等于65岁的患者中，确定了接受有创机械通气的患者。测量和主要结果：在593,990名符合条件的患者中，4,198（0.7%）接受了有创机械通气。平均年龄81.2岁，男性55.5%。无护理需要、支持等级1- 2级和护理需要等级1、护理需要等级2-3级和护理需要等级4-5级患者有创机械通气时1年死亡率分别为43.4%、54.9%、67.8%和74.1%。同样，那些护理需求恶化的人分别为22.8%,24.2%，11.4%和1.9%。结论：在既往护理需求等级为2-5的接受有创机械通气的患者中，76.0-79.2%的患者在1年内死亡或护理需求恶化。这些发现可能有助于患者、其家属和卫生保健专业人员对基线功能和认知状况较差的患者开始有创机械通气的适当性做出共同决策。
OBJECTIVES:To examine 1-year functional outcomes after invasive mechanical ventilation for adults greater than or equal to 65 years with preexisting long-term care-needs.DESIGN:We used medical and long-term care administrative databases. The database included data on functional and cognitive impairments that were assessed with the national standardized care-needs certification system and were categorized into seven care-needs levels based on the total daily estimated care minutes. Primary outcome was mortality and care-needs at 1 year after invasive mechanical ventilation. Outcome was stratified by preexisting care-needs at the time of invasive mechanical ventilation: no care-needs, support level 1–2 and care-needs level 1 (estimated care time 25–49 min), care-needs level 2–3 (50–89 min), and care-needs level 4–5 (≥ 90 min).SETTING:A population-based cohort study in Tochigi Prefecture, one of 47 prefectures in Japan.PATIENTS:Among people greater than or equal to 65 years old registered between June 2014 and February 2018, patients who received invasive mechanical ventilation were identified.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Among 593,990 eligible people, 4,198 (0.7%) received invasive mechanical ventilation. The mean age was 81.2 years, and 55.5% were male. The 1-year mortality rates after invasive mechanical ventilation in patients with no care-needs, support level 1–2 and care-needs level 1, care-needs level 2–3, and care-needs level 4–5 at the time of invasive mechanical ventilation were 43.4%, 54.9%, 67.8%, and 74.1%, respectively. Similarly, those with worsened care-needs were 22.8%, 24.2%, 11.4%, and 1.9%, respectively.CONCLUSIONS:Among patients in preexisting care-needs levels 2–5 who received invasive mechanical ventilation, 76.0–79.2% died or had worsened care-needs within 1 year. These findings may aid shared decision-making among patients, their families, and heath care professionals on the appropriateness of starting invasive mechanical ventilation for people with poor functional and cognitive status at baseline.
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影响因子：
4.1
作者：
Lin HR;Otsubo T;Imanaka Y
通讯作者：
Imanaka Y
DOI：
10.1111/j.1532-5415.2005.53175.x
发表时间：
2005-03-01
影响因子：
6.3
作者：
Tsutsui, T;Muramatsu, N
通讯作者：
Muramatsu, N
影响因子：
3.4
作者：
Richardson, Samuel S.;Sullivan, Greer;Yu, Wei
通讯作者：
Yu, Wei
DOI：
10.1001/jama.274.20.1591
发表时间：
1995
期刊：
JAMA
影响因子：
--
作者：
A. Connors;N. Dawson;N. Desbiens;W. Fulkerson;L. Goldman;W. Knaus;J. Lynn;R. Oye;M. Bergner;A. Damiano;Raymond Hakim;D. Murphy;J. Teno;B. Virnig;D. Wagner;A. W. Wu;Yutaka Yasui;Detra K. Robinson;B. Kreling
通讯作者：
B. Kreling
影响因子：
38.9
作者：
Heyland, DK;Cook, DJ;O'Callaghan, CJ
通讯作者：
O'Callaghan, CJ