接受长时间机械通气的患者的合并症、定植状态与急性住院之间的关联。

The association between comorbid illness, colonization status, and acute hospitalization in patients receiving prolonged mechanical ventilation.

机构信息

Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

出版信息

Respir Care. 2013 Feb;58(2):250-6. doi: 10.4187/respcare.01677.

DOI:10.4187/respcare.01677

PMID:22709565

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4582406/

Abstract

BACKGROUND

Long-term acute care (LTAC) hospitals provide specialized care for survivors of critical illness who require prolonged mechanical ventilation. These chronically ill patients often have multiple comorbidities and are colonized with antibiotic-resistant organisms. We investigated the association of comorbidities and colonization status with outcomes in patients requiring prolonged mechanical ventilation in an LTAC facility. We hypothesized that comorbidity burden and colonization with multiple drug resistant organisms would be associated with worse clinical outcomes.

METHODS

We performed a retrospective, cohort study of 157 mechanically ventilated subjects in an urban LTAC facility admitted from January 2007 to September 2009. Comorbidity burden was documented from pre-admission data using the Charlson Comorbidity Index. Colonization data were obtained from surveillance cultures. Outcomes studied included transfer back to acute care facilities, stay, and ventilator weaning status.

RESULTS

Within 60 days, 58.6% of subjects were transferred back to an acute care facility. The most common reason for transfer was infection/sepsis (37%). The Charlson Comorbidity Index of subjects transferred to acute care, versus those who were not, was 4.9 ± 3.1 versus 3.6 ± 2.7 (P = .01), an odds ratio of 1.1 for each 1-point increase in Charlson Comorbidity Index (95% CI 1.03-1.71, P = .02). Colonization with acinetobacter was associated with higher incidence of transfer (71% vs 51%, P = .01). The odds ratio for transfer to acute care was 1.3 for each additional organism colonizing a subject (95% CI 1.11-1.53, P = .006).

CONCLUSIONS

Higher comorbidity burden and colonization status were associated with increased risk of transfer to acute care. Further investigation is needed to clarify this relationship between comorbidity burden and colonization with change in clinical status.

摘要

背景

长期急性护理（LTAC）医院为需要长时间机械通气的危重病幸存者提供专业护理。这些慢性病患者通常有多种合并症，并定植有抗生素耐药菌。我们研究了 LTAC 设施中需要长时间机械通气的患者的合并症和定植状态与结局的关系。我们假设合并症负担和多种耐药菌定植与更差的临床结局相关。

方法

我们对 2007 年 1 月至 2009 年 9 月在城市 LTAC 设施中接受机械通气的 157 名患者进行了回顾性队列研究。使用 Charlson 合并症指数从入院前数据中记录合并症负担。定植数据来自监测培养物。研究的结局包括转回急性护理机构、住院和呼吸机脱机状态。

结果

在 60 天内，58.6%的患者转回急性护理机构。转诊的最常见原因是感染/败血症（37%）。转至急性护理机构的患者与未转至急性护理机构的患者的 Charlson 合并症指数分别为 4.9 ± 3.1 与 3.6 ± 2.7（P =.01），Charlson 合并症指数每增加 1 分，转移的可能性增加 1.1 倍（95%CI 1.03-1.71，P =.02）。定植鲍曼不动杆菌与较高的转诊率相关（71% vs 51%，P =.01）。定植于患者的每种额外病原体与转诊至急性护理机构的可能性增加 1.3 倍（95%CI 1.11-1.53，P =.006）。