Tomicic Vinko, Espinoza Mauricio, Andresen Max, Molina Jorge, Calvo Mario, Ugarte Héctor, Godoy Jorge, Gálvez Sergio, Maurelia Juan Carlos, Delgado Iris, Esteban Andrés
Departamento de Paciente Crítico Clínica Alemana de Santiago, Facultad de Medicina, Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
Rev Med Chil. 2008 Aug;136(8):959-67. Epub 2008 Oct 7.
The outcome of mechanically ventilated patients can be influenced by factors such as the indication of mechanical ventilation (MV) and ventilator parameters.
To describe the characteristics of patients receiving MV in Chilean critical care units.
Prospective cohort of consecutive adult patients admitted to 19 intensive care units (ICU) from 9 Chilean cities who received MV for more than 12 hours between September lst, 2003, and September 28th, 2003. Demographic data, severity of illness, reason for the initiation of MV, ventilation modes and settings as well as weaning strategies were registered at the initiation and then, daily throughout the course of MV for up to 28 days. ICU and hospital mortality were recorded.
Of 588 patients admitted, 156 (26.5%) received MV (57% males). Mean age and Simplified Acute Physiology Score-II (SAPS II) were 54.6+/-18 years and 40.6+/-16.4 points respectively The most common indications for MV were acute respiratory failure (71.1%) and coma (22.4%). Assist-control mode (71.6%) and synchronized intermittent mandatory ventilation (SIMV) (14,2%) were the most frequently used. T-tube was the main weaning strategy. Mean duration of MV and length of stay in ICU were 7.8+/-8.7 and 11.1+/- 14 days respectively. Overall ICU mortality was 33.9% (53 patients). The main factors independently associated with increased mortality were (1) SAPS II > or =60 points (Odds Ratio (OR), 10.5; 95% CI, 1.04-106.85) and (2) plateau pressure > or =30 cm H2O at second day (OR, 3.9; 95% CI, 1.17-12.97).
Conditions present at the onset of MV and ventilator management were similar to those reported in the literature. Magnitude of multiorgan dysfunction and high plateau pressures are the most important factors associated with mortality.
机械通气患者的预后会受到机械通气（MV）指征和呼吸机参数等因素的影响。
描述智利重症监护病房接受MV患者的特征。
对2003年9月1日至2003年9月28日期间来自智利9个城市的19个重症监护病房（ICU）连续收治的成年患者进行前瞻性队列研究，这些患者接受MV超过12小时。在MV开始时以及MV过程中长达28天的每一天记录人口统计学数据、疾病严重程度、MV起始原因、通气模式和设置以及撤机策略。记录ICU和医院死亡率。
在588例入院患者中，156例（26.5%）接受了MV（男性占57%）。平均年龄和简化急性生理学评分II（SAPS II）分别为54.6±18岁和40.6±16.4分。MV最常见的指征是急性呼吸衰竭（71.1%）和昏迷（22.4%）。辅助控制模式（71.6%）和同步间歇指令通气（SIMV）（14.2%）是最常用的。T管是主要的撤机策略。MV的平均持续时间和在ICU的住院时间分别为7.8±8.7天和11.1±14天。总体ICU死亡率为33.9%（53例患者）。与死亡率增加独立相关的主要因素为：（1）SAPS II≥60分（比值比（OR），10.5；95%可信区间，1.04 - 106.85）；（2）第二天平台压≥30 cm H2O（OR，3.9；95%可信区间，1.17 - 12.97）。
MV开始时的情况和呼吸机管理与文献报道相似。多器官功能障碍的程度和高平台压是与死亡率相关的最重要因素。
