The use of mechanical ventilation in the ED
The use of mechanical ventilation in the ED
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DOI：
10.1016/j.ajem.2011.09.008
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发表时间：
2012-09-01
影响因子：
3.6
通讯作者：
Fisher, Jonathan
中科院分区：
文献类型：
--
作者：
Easter, Benjamin D.;Fischer, Christopher;Fisher, Jonathan
目的：尽管急诊科负责危重患者的初始护理，急诊科提供的危重护理数量也在增加，但关于急诊科机械通气（MV）的数据很少。此外，以急诊科为基础的通气的特点可能会影响在大流行性流感或生物恐怖事件期间呼吸机短缺的规划。该研究检查了美国急诊科中MV的流行病学，包括人口统计学、临床和医院特征；MV适应症；ED住院时间（LOS）；还有住院死亡率。方法：本研究对1993年至2007年全国医院门诊医疗调查ED数据集进行回顾性分析。将通气患者与重症监护病房（ICU）和所有其他急诊科就诊的急诊科患者进行比较。结果：在研究期间，有360万例ED MV就诊（95%置信区间[CI]， 320 - 400万）。机械通气患者和ICU患者的性别、年龄、种族和支付来源相似（P < 0.05）。大约12.5%的通气患者接受了心肺复苏，而在ICU住院患者中，这一比例为1.7%，在所有其他急诊室就诊的患者中，这一比例为0.2% （P < 0.0001）。因此，通气患者的住院死亡率（24%;95% CI, 13.1%-34.9%）明显高于两个对照组（分别为9.3%和2.5%）。通气患者的平均住院时间为197分钟（四分位数范围为112-313分钟），而ICU患者住院时间为224分钟，其他所有急诊科患者住院时间为140分钟。结论：接受ED MV的患者住院死亡率特别高，但他们的ED LOS足以实施循证呼吸机干预。(C) 2012爱思唯尔公司版权所有。
Objectives: Although EDs are responsible for the initial care of critically ill patients and the amount of critical care provided in the ED is increasing, there are few data examining mechanical ventilation (MV) in the ED. In addition, characteristics of ED-based ventilation may affect planning for ventilator shortages during pandemic influenza or bioterrorist events. The study examined the epidemiology of MV in US EDs, including demographic, clinical, and hospital characteristics; indications for MV; ED length of stay (LOS); and in-hospital mortality.Methods: This study was a retrospective review of the 1993 to 2007 National Hospital Ambulatory Medical Care Survey ED data sets. Ventilated patients were compared with ED patients admitted to the intensive care unit (ICU) and to all other ED visits.Results: There were 3.6 million ED MV visits (95% confidence interval [CI], 3.2-4.0 million) over the study period. Sex, age, race, and payment source were similar for mechanically ventilated and ICU patients (P > .05 for all). Approximately 12.5% of ventilated patients underwent cardiopulmonary resuscitation compared with 1.7% of ICU admissions and 0.2% of all other ED visits (P < .0001). Accordingly, in-hospital mortality was significantly higher for ventilated patients (24%; 95% CI, 13.1%-34.9%) than both comparison groups (9.3% and 2.5%, respectively). Median LOS for ventilated patients was 197 minutes (interquartile range, 112-313 minutes) compared with 224 minutes for ICU admissions and 140 minutes for all other ED visits.Conclusions: Patients undergoing ED MV have particularly high in-hospital mortality rates, but their ED LOS is sufficient for implementation of evidence-based ventilator interventions. (C) 2012 Elsevier Inc. All rights reserved.