因特发性肺纤维化入住重症监护病房患者的治疗结果。
Outcomes of patients admitted to the intensive care unit with idiopathic pulmonary fibrosis.
作者信息
Rangappa Pradeep, Moran John L
机构信息
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA.
出版信息
Crit Care Resusc. 2009 Jun;11(2):102-9.
OBJECTIVE
To evaluate outcomes of patients admitted to an intensive care unit with idiopathic pulmonary fibrosis (IPF) and acute respiratory deterioration.
DESIGN
Retrospective cohort study.
SETTING
University-affiliated, tertiary adult ICU.
PARTICIPANTS
All patients admitted to the ICU between January 1996 and December 2006 with an established diagnosis of IPF were identified from review of case notes, ICU charts and electronic hospital records. Patient demographics, ICU investigation and treatment profiles were characterised; final follow-up was electronically from the State Registry.
MAIN OUTCOME MEASURES
Primary study end-point was survival from ICU admission until December 2007; secondary end-points were survival from diagnosis and from first respiratory hospital admission.
RESULTS
24 patients were identified with IPF, diagnosed by lung biopsy (8) and by clinical criteria; 21 patients were admitted with acute respiratory failure, and three postoperatively. Mean age was 66 (SD, 16) years, mean APACHE III score was 82 (SD, 37), and 14 were men. Admission diagnoses were acute exacerbation of IPF (8), pneumonia (10), acute heart failure (3) and postoperative (3). All patients received broad-spectrum antibiotics, and 17 continued to receive corticosteroids prescribed previously. Nineteen patients were mechanically ventilated for a mean of 19.1 days (SD, 25.3); 13 of 19 patients had non-invasive ventilation before mechanical ventilation, and four received only non-invasive ventilation. Sixteen mechanically ventilated patients died in the ICU, another six died in hospital (2-30 days after ICU discharge); and two were discharged home. Median survival (95% CI) was 16 (9-19) days from ICU admission; 55 (18-284) days from first respiratory admission; and 1.05 (0.34-1.75) years from IPF diagnosis.
CONCLUSIONS
Outcomes of patients with IPF admitted to the ICU are poor. Indications for mechanical ventilation appear uncertain.
目的
评估因特发性肺纤维化（IPF）和急性呼吸功能恶化入住重症监护病房（ICU）患者的治疗结果。
设计
回顾性队列研究。
地点
大学附属三级成人ICU。
参与者
通过查阅病例记录、ICU图表和电子医院记录，确定1996年1月至2006年12月期间入住ICU且已确诊为IPF的所有患者。对患者的人口统计学特征、ICU检查和治疗情况进行了描述；最终随访通过国家登记处电子方式进行。
主要观察指标
主要研究终点为从入住ICU至2007年12月的生存率；次要终点为从确诊和首次因呼吸问题入院后的生存率。
结果
确定24例IPF患者，其中8例经肺活检确诊，其余经临床标准确诊；21例因急性呼吸衰竭入院，3例术后入院。平均年龄66（标准差16）岁，平均急性生理与慢性健康状况评分系统（APACHE）III评分为82（标准差37），男性14例。入院诊断为IPF急性加重（8例）、肺炎（10例）、急性心力衰竭（3例）和术后（3例）。所有患者均接受了广谱抗生素治疗，17例继续接受先前开具的皮质类固醇治疗。19例患者接受机械通气，平均通气时间为19.1天（标准差25.3）；19例患者中有13例在机械通气前接受了无创通气，4例仅接受无创通气。16例接受机械通气的患者在ICU死亡，另外6例在医院死亡（ICU出院后2 - 30天）；2例出院回家。从入住ICU起的中位生存期（95%置信区间）为16（9 - 19）天；从首次因呼吸问题入院起为55（18 - 284）天；从IPF确诊起为1.05（0.34 - 1.75）年。
结论
入住ICU的IPF患者治疗结果较差。机械通气的指征似乎不明确。
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