Daly Barbara J, Douglas Sara L, Gordon Nahida H, Kelley Carol G, O'Toole E, Montenegro Hugo, Higgins Patricia
School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106-4904, USA.
Am J Crit Care. 2009 Sep;18(5):456-64; quiz 465. doi: 10.4037/ajcc2009580.
Data on likely postdischarge outcomes are important for decision making about chronically critically ill patients. It seems reasonable to categorize outcomes into "better" or overall desirable states and "worse" or generally undesirable states. Survival, being at home, and being cognitively intact are commonly identified as important to quality of life and thus may be combined to describe composite outcome states.
To categorize postdischarge outcome states of chronically critically ill patients and identify predictors of better and worse states.
Reanalysis of data from a trial of a disease management program for chronically critically ill patients. Two composite outcomes were created: (1) the "better" outcome: no cognitive impairment at 2 months after discharge and alive and at home at 4 months (ie, met all 3 criteria), and (2) the "worse" outcome: cognitive impairment 2 months after discharge, or death after discharge, or not living at home 4 months after discharge (ie, met at least 1 of these criteria).
Of 218 patients not requiring ventilatory support at discharge, 111 (50.9%) had a better outcome. Of 159 patients who were cognitively intact at discharge, 111 (69.8%) had a better outcome. Of the 39 patients who required ventilatory support at discharge, only 1 (3%) achieved the better outcome. Of 98 patients who were cognitively impaired at discharge, only 29 (30%) had the better outcome.
Need for mechanical ventilatory support and persistent cognitive impairment at discharge were associated with worse outcomes 4 months after discharge.
关于出院后可能出现的结果的数据对于慢性危重症患者的决策至关重要。将结果分为“较好”或总体理想状态以及“较差”或一般不理想状态似乎是合理的。生存、在家以及认知功能完好通常被认为对生活质量很重要，因此可以结合起来描述综合结果状态。
对慢性危重症患者出院后的结果状态进行分类，并确定较好和较差状态的预测因素。
对一项针对慢性危重症患者的疾病管理项目试验的数据进行重新分析。创建了两个综合结果：（1）“较好”结果：出院后2个月无认知障碍，出院后4个月存活且在家（即满足所有3项标准）；（2）“较差”结果：出院后2个月出现认知障碍，或出院后死亡，或出院后4个月不在家（即满足这些标准中的至少1项）。
在出院时不需要通气支持的218例患者中，111例（50.9%）有较好的结果。在出院时认知功能完好的159例患者中，111例（69.8%）有较好的结果。在出院时需要通气支持的39例患者中，只有1例（3%）取得了较好的结果。在出院时存在认知障碍的98例患者中，只有29例（30%）有较好的结果。
出院时需要机械通气支持和持续存在认知障碍与出院后4个月的较差结果相关。
