省级长时间通气撤机中心患者特征和结局：一项回顾性队列研究。
Patient characteristics and outcomes of a provincial prolonged-ventilation weaning centre: a retrospective cohort study.
机构信息
Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario M5T 1P8, Canada.
出版信息
Can Respir J. 2012 May-Jun;19(3):216-20. doi: 10.1155/2012/358265.
BACKGROUND
Growing numbers of critically ill patients require prolonged mechanical ventilation and experience difficulty with weaning. Specialized centres may facilitate weaning through focused interprofessional expertise with an emphasis on rehabilitation.
OBJECTIVE
To characterize the population of a specialized prolonged-ventilation weaning centre (PWC) in Ontario, and to report weaning, mobility, discharge and survival outcomes.
METHODS
Data from consecutively admitted patients were retrospectively extracted from electronic and paper medical records by research staff and verified by the primary investigator.
RESULTS
From January 2004 to March 2011, 144 patients were admitted: 115 (80%) required ventilator weaning, and 29 (20%) required tracheostomy weaning or noninvasive ventilation. Intensive care unit length of stay before admission was a median 51 days (interquartile range [IQR] 35 to 86 days). Of the patients admitted for ventilator weaning, 76 of 115 (66% [95% CI 55% to 75%]) achieved a 24 h tracheostomy mask trial in a median of 15 days (IQR eight to 25 days). Weaning success, defined as no further ventilation for seven consecutive days, was achieved by 61 patients (53% [95% CI 44% to 62%]) in a median duration of 62 days (IQR 46 to 95 days) of ventilation, and 14 days (IQR nine to 29 days) after PWC admission. Seventeen patients died during admission. Of the 91 patients discharged from the PWC for one year, 43 (47.3% [95% CI 37.3% to 57.4%]) survived; of the 78 discharged for two years, 27 (34.6% [95% CI 25.0% to 45.7%]) were alive; of the 53 discharged for three years, 19 (35.9% [95% CI 24.3% to 49.3%]) were alive; and seven of 22 (31.8% [95% CI 16.4% to 52.7%]) survived to five years.
CONCLUSIONS
Weaning success was moderate despite a prolonged intensive care unit stay before admission, but was comparable with studies reporting weaning outcomes from centres in other countries. Few patients survived to five years.
背景
越来越多的危重症患者需要长时间机械通气，并在撤机过程中遇到困难。专门的中心可以通过专注的跨专业专业知识来促进撤机，重点是康复。
目的
描述安大略省专门的长时间通气撤机中心 (PWC) 的人群特征，并报告撤机、活动能力、出院和生存结果。
方法
研究人员通过电子和纸质病历从连续入院的患者中回顾性提取数据，并由主要研究者进行验证。
结果
2004 年 1 月至 2011 年 3 月，共收治 144 例患者：115 例（80%）需要呼吸机撤机，29 例（20%）需要气管切开术撤机或无创通气。入院前 ICU 住院时间中位数为 51 天（四分位距 [IQR] 35 至 86 天）。115 例接受呼吸机撤机的患者中，76 例（66% [95%CI 55%至 75%]）在中位数 15 天（IQR 8 至 25 天）内完成了 24 小时气管造口面罩试验。撤机成功定义为连续 7 天无需进一步通气，61 例患者（53% [95%CI 44%至 62%]）在中位数 62 天（IQR 46 至 95 天）的通气时间内达到成功，在 PWC 入院后中位数 14 天（IQR 9 至 29 天）。17 例患者在住院期间死亡。91 例出院患者在 PWC 接受了一年治疗，43 例（47.3% [95%CI 37.3%至 57.4%]）存活；78 例出院接受两年治疗，27 例（34.6% [95%CI 25.0%至 45.7%]）存活；53 例出院接受三年治疗，19 例（35.9% [95%CI 24.3%至 49.3%]）存活；22 例中，7 例（31.8% [95%CI 16.4%至 52.7%]）存活至五年。
结论
尽管入院前 ICU 住院时间较长，但撤机成功率中等，但与其他国家中心报告的撤机结果相当。很少有患者存活五年。
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