Disability among Elderly Survivors of Mechanical Ventilation
Disability among Elderly Survivors of Mechanical Ventilation
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DOI：
10.1164/rccm.201002-0301oc
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发表时间：
2011-04-15
影响因子：
24.7
通讯作者：
Degenholtz, Howard B.
中科院分区：
文献类型：
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作者：
Barnato, Amber E.;Albert, Steven M.;Degenholtz, Howard B.
理由：对机械通气 (MV) 老年幸存者的长期功能结果的研究仅限于局部样本和有偏差的回顾性、代理报告的入院前功能状态。目标：与未使用 MV 的住院相比，评估 MV 住院对残疾的影响，并考虑到前瞻性评估的先前功能状态。方法：对加入 Medicare 当前受益人的 65 岁及以上 Medicare 受益人进行基于人群的回顾性纵向队列研究调查，1996-2003。测量和主要结果：残疾的预先测量和事后测量包括行动困难和日常生活残疾评分的加权活动，范围从0（非残疾）到100（完全残疾），基于每隔一年收集的自我报告的健康和功能状态。在 7 个日历年的 54,771 人年 (PY) 观察数据中，42,890 人年未住院，11,347 人年没有 MV 住院，534 人年因 MV 住院。 1 年死亡率分别为 8.9%、23.9% 和 72.5%。与 MV 住院后幸存的典型患者（调整后的日常生活活动能力评分 [95% 置信区间] 14.9 [12.2-17.7]；调整后的活动困难评分 [95% 置信区间] 25.4 [22.4-28.4]）相比，在其他方面相同的无 MV 住院存活的患者 (11.5 [11.1-11.9] 和 22.3 [21.8-22.9]) 或未住院的人 (8.0 [7.9-8.1] 和 13.4 [13.3-13.6])。 结论：与没有 MV 住院的幸存者相比，MV 幸存者残疾的边际增加幅度更大，大于根据先前的功能状态预测。
Rationale: Studies of long-term functional outcomes of elderly survivors of mechanical ventilation (MV) are limited to local samples and biased retrospective, proxy-reported preadmission functional status.Objectives: To assess the impact on disability of hospitalization with MV, compared with hospitalization without MV, accounting for prospectively assessed prior functional status.Methods: Retrospective population-based longitudinal cohort study of Medicare beneficiaries age 65 and older enrolled in the Medicare Current Beneficiary Survey, 1996-2003.Measurements and Main Results: Premeasures and postmeasures of disability included mobility difficulty and weighted activities of daily living disability scores ranging from 0 (not disabled) to 100 (completely disabled) based on self-reported health and functional status collected 1 year apart. Among 54,771 person-years (PY) of observation over 7 calendar years of data, 42,890 PY involved no hospitalization, 11,347 PY involved a hospitalization without MV, and 534 PY included a hospitalization with MV. Mortality at 1 year was 8.9%, 23.9%, and 72.5%, respectively. The level of disability at the post-assessment was substantially higher for a prototypical patient who survived after hospitalization with MV (adjusted activities of daily living disability score [95% confidence interval] 14.9 [12.2-17.7]; adjusted mobility difficulty score [95% confidence interval] 25.4 [22.4-28.4]) compared with an otherwise identical patient who survived hospitalization without MV (11.5 [11.1-11.9] and 22.3 [21.8-22.9]) or who was not hospitalized (8.0 [7.9-8.1] and 13.4 [13.3-13.6]).Conclusions: The greater marginal increase in disability among survivors of MV compared with survivors of hospitalization without MV is larger than would be predicted from prior functional status.