Aix-Marseille Univ, URMITE CNRS-UMR 7278, Marseille, France; APHM, Hôpital Nord, Réanimation, Marseille, France.
PLoS One. 2013 Sep 19;8(9):e74937. doi: 10.1371/journal.pone.0074937. eCollection 2013.
It has been suggested that delayed intensive care unit (ICU) transfer is associated with increased mortality for patients with community-acquired pneumonia (CAP). However, ICU admission policies and patient epidemiology vary widely across the world depending on local hospital practices and organizational constraints. We hypothesized that the time from the onset of CAP symptoms to invasive mechanical ventilation could be a relevant prognostic factor.
One hundred patients with a CAP and necessitating invasive mechanical ventilation were included. Prospectively collected data were retrospectively analysed. Two study groups were identified based on the time of the initiation of invasive mechanical ventilation (rapid respiratory failure requiring mechanical ventilation within 72 h of the onset of CAP and progressive respiratory failure requiring invasive mechanical ventilation 4 or more days after the onset of CAP).
Excepting more COPD patients in the rapid respiratory failure group and more patients with diabetes in the progressive respiratory failure group, these patients had similar characteristics. The overall in-hospital mortality rate was 28% in the rapid respiratory failure group and 51% in the progressive respiratory failure group (P = 0.03). The ICU and the day 30 mortality rates were higher in the progressive respiratory failure group (47% vs. 23%, P = 0.02; and 37.7% vs. 21.3%, P = 0.03; respectively). After adjusting for the propensity score and other potential confounding factors, progressive respiratory failure remained associated with hospital mortality only after 12 days of invasive mechanical ventilation.
This study suggested that the duration or delay in the time to intubation from the onset of CAP symptoms was associated with the outcomes in those patients who ultimately required invasive mechanical ventilation.
有研究表明，对于社区获得性肺炎（CAP）患者，延迟转入重症监护病房（ICU）与死亡率升高有关。然而，由于各国的 ICU 收治政策和患者流行病学特征存在差异，其差异主要取决于当地医院的实践和组织限制。我们假设从 CAP 症状发作到进行有创机械通气的时间可能是一个相关的预后因素。
共纳入 100 例需要进行有创机械通气的 CAP 患者。回顾性分析前瞻性收集的数据。根据开始有创机械通气的时间，将患者分为两组：快速呼吸衰竭组（CAP 发作后 72 小时内需要机械通气治疗的急性呼吸衰竭）和进展性呼吸衰竭组（CAP 发作后 4 天或更长时间需要有创机械通气的慢性呼吸衰竭）。
除了快速呼吸衰竭组中 COPD 患者更多，进展性呼吸衰竭组中糖尿病患者更多外，这些患者具有相似的特征。快速呼吸衰竭组的总住院死亡率为 28%，进展性呼吸衰竭组为 51%（P=0.03）。进展性呼吸衰竭组的 ICU 入住率和第 30 天死亡率更高（47% vs. 23%，P=0.02；37.7% vs. 21.3%，P=0.03）。在校正倾向评分和其他潜在混杂因素后，仅在进行有创机械通气 12 天后，进展性呼吸衰竭仍与住院死亡率相关。
本研究表明，从 CAP 症状发作到插管的时间长短或延迟与最终需要进行有创机械通气的患者的结局相关。
