Modawal Arvind, Candadai Niranjana P, Mandell Karen M, Moore Eileen S, Hornung Richard W, Ho Mona L, Tsevat Joel
Section of Geriatric Medicine, Department of Family Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267-0535, USA.
Arch Phys Med Rehabil. 2002 Feb;83(2):154-7. doi: 10.1053/apmr.2002.29614.
To determine outcomes of difficult-to-wean, ventilator-dependent patients transferred from intensive care units to rehabilitation hospitals and to determine predictors of weaning success in such patients.
A retrospective cohort study.
A rehabilitation facility.
One hundred forty-five difficult-to-wean patients (55.2% men; 83.4% white; mean age +/- standard deviation, 65.8 +/- 16.4y) transferred to a rehabilitation facility between July 1994 and June 1996.
Not applicable.
Demographic and clinical data, including variables identified previously as predictive of weaning success among highly selected populations.
Patients' Gillespie categories (reason for ventilator dependency) included "other medical conditions" (eg, pneumonia, neurologic) in 42.1% of the cases, postoperative in 24.8%, previous lung disease (eg, chronic obstructive pulmonary disease, interstitial lung disease) in 15.2%, trauma in 11.7%, respiratory failure with multisystem failure in 3.4%, and uncomplicated acute lung injury (acute respiratory distress syndrome) in 2.8%. Of 145 patients, 50.3% were completely weaned, 4.8% were partially weaned, and 44.8% remained ventilator dependent. In a stepwise multivariable logistic regression analysis, significant predictors of weaning success included white race (odds ratio [OR] = 3.4), serum albumin level (OR = 2.1g/dL), and blood urea nitrogen (BUN) level (OR = .97mg/dL); in addition, compared with postoperative patients, patients with "other medical conditions" (OR = .15) or previous lung disease (OR = .08) were less likely to be weaned (area under receiver operating characteristic curve = .76). Among 31 long-term survivors who were interviewed at least 6 months after discharge from the rehabilitation facility, 58.1% rated their health-related quality of life as good or better.
Half of the patients admitted to a rehabilitation facility were weaned from their ventilators. Predictors of weaning success included race, BUN level, albumin level, and reason for ventilator dependency.
确定从重症监护病房转至康复医院的撤机困难、依赖呼吸机的患者的预后，并确定此类患者撤机成功的预测因素。
一项回顾性队列研究。
一家康复机构。
1994年7月至1996年6月期间转至一家康复机构的145例撤机困难患者（男性占55.2%；白人占83.4%；平均年龄±标准差为65.8±16.4岁）。
不适用。
人口统计学和临床数据，包括先前确定的在高度选择人群中预测撤机成功的变量。
患者的吉莱斯皮分类（呼吸机依赖原因）包括“其他内科疾病”（如肺炎、神经系统疾病）占42.1%，术后占24.8%，既往肺部疾病（如慢性阻塞性肺疾病、间质性肺疾病）占15.2%，创伤占11.7%，呼吸衰竭合并多系统衰竭占3.4%，无并发症的急性肺损伤（急性呼吸窘迫综合征）占2.8%。145例患者中，50.3%完全撤机，4.8%部分撤机，44.8%仍依赖呼吸机。在逐步多变量逻辑回归分析中，撤机成功的显著预测因素包括白人种族（比值比[OR]=3.4）、血清白蛋白水平（OR=2.1g/dL）和血尿素氮（BUN）水平（OR=0.97mg/dL）；此外，与术后患者相比，患有“其他内科疾病”（OR=0.15）或既往肺部疾病（OR=0.08）的患者撤机可能性较小（受试者操作特征曲线下面积=0.76）。在从康复机构出院后至少6个月接受访谈的31例长期存活者中，58.1%将其与健康相关的生活质量评为良好或更好。
入住康复机构的患者中有一半成功撤机。撤机成功的预测因素包括种族、BUN水平、白蛋白水平和呼吸机依赖原因。
