Esteban Andrés, Anzueto Antonio, Frutos Fernando, Alía Inmaculada, Brochard Laurent, Stewart Thomas E, Benito Salvador, Epstein Scott K, Apezteguía Carlos, Nightingale Peter, Arroliga Alejandro C, Tobin Martin J
Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Carretera de Toledo Km 12, 5, 28905 Getafe, Madrid, Spain.
JAMA. 2002 Jan 16;287(3):345-55. doi: 10.1001/jama.287.3.345.
The outcome of patients receiving mechanical ventilation for particular indications has been studied, but the outcome in a large number of unselected, heterogeneous patients has not been reported.
To determine the survival of patients receiving mechanical ventilation and the relative importance of factors influencing survival.
DESIGN, SETTING, AND SUBJECTS: Prospective cohort of consecutive adult patients admitted to 361 intensive care units who received mechanical ventilation for more than 12 hours between March 1, 1998, and March 31, 1998. Data were collected on each patient at initiation of mechanical ventilation and daily throughout the course of mechanical ventilation for up to 28 days.
All-cause mortality during intensive care unit stay.
Of the 15 757 patients admitted, a total of 5183 (33%) received mechanical ventilation for a mean (SD) duration of 5.9 (7.2) days. The mean (SD) length of stay in the intensive care unit was 11.2 (13.7) days. Overall mortality rate in the intensive care unit was 30.7% (1590 patients) for the entire population, 52% (120) in patients who received ventilation because of acute respiratory distress syndrome, and 22% (115) in patients who received ventilation for an exacerbation of chronic obstructive pulmonary disease. Survival of unselected patients receiving mechanical ventilation for more than 12 hours was 69%. The main conditions independently associated with increased mortality were (1) factors present at the start of mechanical ventilation (odds ratio [OR], 2.98; 95% confidence interval [CI], 2.44-3.63; P<.001 for coma), (2) factors related to patient management (OR, 3.67; 95% CI, 2.02-6.66; P<.001 for plateau airway pressure >35 cm H(2)O), and (3) developments occurring over the course of mechanical ventilation (OR, 8.71; 95% CI, 5.44-13.94; P<.001 for ratio of PaO(2) to fraction of inspired oxygen <100).
Survival among mechanically ventilated patients depends not only on the factors present at the start of mechanical ventilation, but also on the development of complications and patient management in the intensive care unit.
已对因特定指征接受机械通气的患者的预后进行了研究，但大量未经筛选的异质性患者的预后尚未见报道。
确定接受机械通气患者的生存率以及影响生存的因素的相对重要性。
设计、设置和研究对象：对1998年3月1日至1998年3月31日期间入住361个重症监护病房且接受机械通气超过12小时的连续成年患者进行前瞻性队列研究。在机械通气开始时以及整个机械通气过程中每天（最长28天）收集每位患者的数据。
重症监护病房住院期间的全因死亡率。
在15757名入院患者中，共有5183名（33%）接受了机械通气，平均（标准差）持续时间为5.9（7.2）天。重症监护病房的平均（标准差）住院时间为11.2（13.7）天。整个人群的重症监护病房总体死亡率为30.7%（1590名患者），因急性呼吸窘迫综合征接受通气的患者为52%（120名），因慢性阻塞性肺疾病加重接受通气的患者为22%（115名）。接受机械通气超过12小时的未经筛选患者的生存率为69%。与死亡率增加独立相关的主要情况为：（1）机械通气开始时存在的因素（比值比[OR]，2.98；95%置信区间[CI]，2.44 - 3.63；昏迷的P<0.001），（2）与患者管理相关的因素（OR，3.67；95%CI，2.02 - 6.66；平台气道压>35 cm H₂O的P<0.001），以及（3）机械通气过程中出现的情况（OR，8.71；95%CI，5.44 - 13.94；动脉血氧分压与吸入氧分数之比<100的P<0.001）。
机械通气患者的生存不仅取决于机械通气开始时存在的因素，还取决于重症监护病房中并发症的发生情况和患者管理。
