Kern H, Redlich U, Hotz H, von Heymann C, Grosse J, Konertz W, Kox W J
Department of Anesthesiology and Intensive Care, University Hospital Charité, Campus Mitte, Humboldt University of Berlin, Schumannstrasse 20/21, 10098 Berlin, Germany.
Intensive Care Med. 2001 Feb;27(2):407-15. doi: 10.1007/s001340000802.
To identify the risk for prolonged mechanical ventilation in cardiac surgical patients.
Prospective study with retrospective combination of a second database.
Six hundred and eighty-seven patients after cardiac surgery over a period of 12 months.
Demographic data were recorded preoperatively, and surgical procedures intraoperatively using a surgical database designed for quality control. Length of ICU and hospital stay, and hospital outcome were recorded. Severity of illness was assessed daily using APACHE II, SAPS II, and Organ Failure Score. Intensity of treatment and nursing care was monitored by means of the Therapeutic Intervention Scoring System (TISS). Univariate and multivariate analyses were performed using logistic regression. The predictive value of the identified variables was tested by the Wilcoxon test using the receiver operating characteristic curve.
Sixty-two patients (9.0%) were ventilated for > 48 h and accounted for 42.8% of the total costs in the ICU. The pre- and intraoperatively collected data produced a model with weak predictive capacity for prolonged ventilation [area under curve (AUC) 73.22 and 71.08, respectively]. The use of TISS and SAPS postoperatively resulted in an effective model of prediction (AUC 93.76). Adding the occurrence of reoperation, reintubation, emergency transfusion, intraaortic balloon pumping, and need for total parenteral nutrition to the model further improved its predictive capacity (AUC 94.74).
The present results strongly suggest that data collected postoperatively using established scoring systems as well as documented events of high clinical impact for risk assessment and quality control are reliable predictors of prolonged ventilation.
确定心脏手术患者机械通气时间延长的风险。
前瞻性研究，并对第二个数据库进行回顾性合并。
12个月内687例心脏手术后患者。
术前记录人口统计学数据，术中使用为质量控制设计的手术数据库记录手术过程。记录重症监护病房（ICU）住院时间、住院时间及住院结局。每日使用急性生理与慢性健康状况评分系统II（APACHE II）、简化急性生理学评分II（SAPS II）和器官衰竭评分评估疾病严重程度。通过治疗干预评分系统（TISS）监测治疗和护理强度。采用逻辑回归进行单因素和多因素分析。使用受试者工作特征曲线通过Wilcoxon检验对所确定变量的预测价值进行检验。
62例患者（9.0%）机械通气时间超过48小时，占ICU总费用的42.8%。术前和术中收集的数据生成了一个对机械通气时间延长预测能力较弱的模型[曲线下面积（AUC）分别为73.22和71.08]。术后使用TISS和SAPS生成了一个有效的预测模型（AUC 93.76）。将再次手术、再次插管、紧急输血、主动脉内球囊反搏及全胃肠外营养需求的发生情况纳入该模型，进一步提高了其预测能力（AUC 94.74）。
目前的结果强烈表明，术后使用既定评分系统收集的数据以及记录的具有高临床影响的事件，对于风险评估和质量控制而言，是机械通气时间延长的可靠预测指标。
