The changing epidemiology of mechanical ventilation: a population-based study.
The changing epidemiology of mechanical ventilation: a population-based study.
复制标题
DOI：
10.1177/0885066605282784
复制
发表时间：
2006-05-01
影响因子：
3.1
通讯作者：
Carey, Timothy S
中科院分区：
文献类型：
--
作者：
Carson, Shannon S;Cox, Christopher E;Carey, Timothy S
美国重症监护病床的数量一直在大幅增加，但目前还不清楚这些额外的病床是如何使用的。急性呼吸衰竭的机械通气几乎总是需要ICU护理，并且可能是人口水平上重症监护资源需求的可靠指标。本研究的目的是测量全州人群中机械通气年发病率的变化。北卡罗来纳州医院出院数据库包含北卡罗来纳州非联邦、非精神病医院的所有出院数据。作者提取了1996年至2002年期间国际疾病分类第9版临床改良手术代码中机械通气成人患者的数据。成人机械通气的发病率从1996年的284/10万上升到2002年的314/10万，增长了11%（P <0.05）。虽然年龄>64岁的患者每年机械通气的年龄特异性发病率最高，但发病率增加最多的是年轻年龄组（18-64岁增加19%，而年龄>64岁增加4%）。平均Charlson评分从1.76 ± 1.73增加到1.89 ± 1.86（P < .001）。肾脏疾病在需要机械通气的患者中变得更加普遍（1996年为17%，2002年为24%）。经医疗消费物价指数调整后的医院收费增加了12%。出院回家的比例从45.4%下降到34.4%，出院到疗养院的比例从7.3%上升到10.7%。机械通气的发生率正在增加，并且这种增加与更高的合并症负担和更少的出院回家有关。
The number of critical care beds in the United States has been increasing considerably, but it is unclear how these additional beds have been used. Mechanical ventilation for acute respiratory failure almost always demands ICU care and is likely to be a reliable indicator of critical care resource requirements on a population level. The objective of this study was to measure changes in the yearly incidence of mechanical ventilation in a statewide population. The North Carolina Hospital Discharge Database contains data on all discharges from nonfederal, nonpsychiatric hospitals in North Carolina. Authors extracted data on adult patients with International Classification of Diseases, 9th Revision, Clinical Modification procedure codes for mechanical ventilation from 1996 to 2002. The incidence of mechanical ventilation for adults grew from 284/100,000 population in 1996 to 314/100,000 in 2002, an increase of 11% (P < .05). While patients aged >64 had the highest age-specific incidence of mechanical ventilation each year, the greatest increase in incidence occurred in younger age groups (19% increase for age 18-64 vs 4% increase for age >64). The mean Charlson score increased from 1.76 +/- 1.73 to 1.89 +/- 1.86 (P < .001). Renal disease became more prevalent among patients requiring mechanical ventilation (17% of patients in 1996 vs 24% in 2002). Hospital charges adjusted for the medical consumer price index increased by 12%. The proportion of patients discharged to home declined from 45.4% to 34.4%, and discharges to nursing homes grew from 7.3% to 10.7%. The incidence of mechanical ventilation is increasing, and the increase is associated with a higher burden of comorbidities and fewer discharges to home.