Center for Research on Health Care, 200 Meyran Avenue, Pittsburgh, PA 15213, USA.
Am J Respir Crit Care Med. 2011 Apr 15;183(8):1037-42. doi: 10.1164/rccm.201002-0301OC. Epub 2010 Nov 5.
Studies of long-term functional outcomes of elderly survivors of mechanical ventilation (MV) are limited to local samples and biased retrospective, proxy-reported preadmission functional status.
To assess the impact on disability of hospitalization with MV, compared with hospitalization without MV, accounting for prospectively assessed prior functional status.
Retrospective population-based longitudinal cohort study of Medicare beneficiaries age 65 and older enrolled in the Medicare Current Beneficiary Survey, 1996-2003.
Premeasures and postmeasures of disability included mobility difficulty and weighted activities of daily living disability scores ranging from 0 (not disabled) to 100 (completely disabled) based on self-reported health and functional status collected 1 year apart. Among 54,771 person-years (PY) of observation over 7 calendar years of data, 42,890 PY involved no hospitalization, 11,347 PY involved a hospitalization without MV, and 534 PY included a hospitalization with MV. Mortality at 1 year was 8.9%, 23.9%, and 72.5%, respectively. The level of disability at the postassessment was substantially higher for a prototypical patient who survived after hospitalization with MV (adjusted activities of daily living disability score [95% confidence interval] 14.9 [12.2-17.7]; adjusted mobility difficulty score [95% confidence interval] 25.4 [22.4-28.4]) compared with an otherwise identical patient who survived hospitalization without MV (11.5 [11.1-11.9] and 22.3 [21.8-22.9]) or who was not hospitalized (8.0 [7.9-8.1] and 13.4 [13.3-13.6]).
The greater marginal increase in disability among survivors of MV compared with survivors of hospitalization without MV is larger than would be predicted from prior functional status.
有关机械通气（MV）老年幸存者长期功能结局的研究仅限于当地样本，且存在回顾性、代理报告的入院前功能状态偏倚。
评估 MV 相关住院治疗与非 MV 相关住院治疗对残疾的影响，同时考虑前瞻性评估的入院前功能状态。
对参加 1996-2003 年 Medicare 现行受益调查的 Medicare 受益人的基于人群的回顾性纵向队列研究。
残疾的预测量和后测量包括根据自我报告的健康和功能状态收集的一年后移动困难和加权日常生活活动残疾评分，范围从 0（无残疾）到 100（完全残疾）。在 7 年的数据中观察到的 54771 人年（PY）中，42890PY 无住院，11347PY 无 MV 相关住院，534PY 有 MV 相关住院。1 年死亡率分别为 8.9%、23.9%和 72.5%。与无 MV 相关住院且存活的典型患者相比，存活的 MV 相关住院患者的残疾程度在后评估中明显更高（调整后的日常生活活动残疾评分[95%置信区间]为 14.9[12.2-17.7]；调整后的移动困难评分[95%置信区间]为 25.4[22.4-28.4]），而与无住院治疗且存活的患者（11.5[11.1-11.9]和 22.3[21.8-22.9]）或未住院的患者（8.0[7.9-8.1]和 13.4[13.3-13.6]）相比。
与非 MV 相关住院治疗的幸存者相比，MV 幸存者的残疾程度增加幅度更大，超出了先前功能状态的预测。
