Mamary A James, Kondapaneni Shrikant, Vance Gwendolyn B, Gaughan John P, Martin Ubaldo J, Criner Gerard J
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.
Clin Med Insights Circ Respir Pulm Med. 2011 Apr 25;5:17-26. doi: 10.4137/CCRPM.S6649.
Prolonged mechanical ventilation is increasingly common. It is expensive and associated with significant morbidity and mortality. Our objective is to comprehensively characterize patients admitted to a Ventilator Rehabilitation Unit (VRU) for weaning and identify characteristics associated with survival.
182 consecutive patients over 3.5 years admitted to Temple University Hospital (TUH) VRU were characterized. Data were derived from comprehensive chart review and a prospectively collected computerized database. Survival was determined by hospital records and social security death index and mailed questionnaires.
Upon admission to the VRU, patients were hypoalbuminemic (albumin 2.3 ± 0.6 g/dL), anemic (hemoglobin 9.6 ± 1.4 g/dL), with moderate severity of illness (APACHE II score 10.7 + 4.1), and multiple comorbidities (Charlson index 4.3 + 2.3). In-hospital mortality (19%) was related to a higher Charlson Index score (P = 0.006; OR 1.08-1.6), and APACHE II score (P = 0.016; OR 1.03-1.29). In-hospital mortality was inversely related to admission albumin levels (P = 0.023; OR 0.17-0.9). The presence of COPD as a comorbid illness or primary determinant of respiratory failure and higher VRU admission APACHE II score predicted higher long-term mortality. Conversely, higher VRU admission hemoglobin was associated with better long term survival (OR 0.57-0.90; P = 0.0006).
Patients receiving prolonged ventilation are hypoalbuminemic, anemic, have moderate severity of illness, and multiple comorbidities. Survival relates to these factors and the underlying illness precipitating respiratory failure, especially COPD.
长期机械通气越来越常见。其费用高昂，且与显著的发病率和死亡率相关。我们的目标是全面描述入住呼吸机康复单元（VRU）进行撤机的患者特征，并确定与生存相关的特征。
对3.5年期间连续入住坦普尔大学医院（TUH）VRU的182例患者进行了特征描述。数据来自全面的病历审查和前瞻性收集的计算机数据库。通过医院记录、社会保障死亡指数和邮寄问卷来确定生存情况。
入住VRU时，患者存在低白蛋白血症（白蛋白2.3±0.6g/dL）、贫血（血红蛋白9.6±1.4g/dL），疾病严重程度为中度（急性生理与慢性健康状况评分系统II [APACHE II]评分为10.7 + 4.1），且有多种合并症（查尔森指数为4.3 + 2.3）。院内死亡率（19%）与较高的查尔森指数评分（P = 0.006；比值比[OR]为1.08 - 1.6）和APACHE II评分（P = 0.016；OR为1.03 - 1.29）相关。院内死亡率与入院时白蛋白水平呈负相关（P = 0.023；OR为0.17 - 0.9）。慢性阻塞性肺疾病（COPD）作为合并症或呼吸衰竭的主要决定因素以及较高的VRU入院APACHE II评分预示着更高的长期死亡率。相反，较高的VRU入院血红蛋白水平与更好的长期生存相关（OR为0.57 - 0.90；P = 0.0006）。
接受长期通气的患者存在低白蛋白血症、贫血，疾病严重程度为中度，且有多种合并症。生存与这些因素以及引发呼吸衰竭的基础疾病相关，尤其是COPD。
