1Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle, WA. 2Division of Pulmonary and Critical Care Medicine, University of Washington, Harborview Medical Center, Seattle, WA. 3Department of Biostatistics, University of Washington, Seattle, WA. 4Department of Pharmacy, University of Washington, Seattle, WA. 5Department of Epidemiology, University of Washington, Seattle, WA.
Crit Care Med. 2014 Jul;42(7):1610-8. doi: 10.1097/CCM.0000000000000322.
To describe long-term survival in patients with severe acute respiratory distress syndrome and assess differences in patient characteristics and outcomes among those who receive rescue therapies (prone position ventilation, inhaled nitric oxide, or inhaled epoprostenol) versus conventional treatment.
Cohort study of patients with severe hypoxemia.
University-affiliated level 1 trauma center.
Patients diagnosed with severe acute respiratory distress syndrome within 72 hours of ICU admission between January 1, 2008, and December 31, 2011.
None.
Data were abstracted from the medical record and included demographic and clinical variables, hospital and ICU length of stay, discharge disposition, and hospital costs. Patient-level data were linked to the Washington State Death Registry. Kaplan-Meier methods and Cox's proportional hazards models were used to estimate survival and hazard ratios. Four hundred twenty-eight patients meeting study inclusion criteria were identified; 62 (14%) were initiated on a rescue therapy. PaO2/FIO2 ratios were comparable at admission between patients treated with a rescue therapy and those treated conventionally but were substantially lower by 72 hours in those who received rescue therapies (54 ± 17 vs 69 ± 17 mm Hg; p < 0.01). For the entire cohort, estimated survival probability at 3 years was 55% (95% CI, 51-61%). Among 280 hospital survivors (65%), 3-year survival was 85% (95% CI, 80-89%). The relative hazard of in-hospital mortality was 68% higher among patients who received rescue therapy compared with patients treated conventionally (95% CI, 8-162%; p = 0.02). For long-term survival, the hazard ratio of death following ICU admission was 1.56 (95% CI, 1.02-2.37; p = 0.04), comparing rescue versus conventional treatment.
Despite high hospital mortality, severe acute respiratory distress syndrome patients surviving to hospital discharge have relatively good long-term survival. Worsening hypoxemia was associated with initiation of rescue therapy. Patients on rescue therapy had higher in-hospital mortality; however, survivors to hospital discharge had long-term survival that was comparable to other acute respiratory distress syndrome survivors.
描述严重急性呼吸窘迫综合征患者的长期生存情况，并评估接受抢救治疗（俯卧位通气、吸入一氧化氮或吸入前列环素）与常规治疗的患者在患者特征和结局方面的差异。
入住 ICU 72 小时内诊断为严重低氧血症的患者队列研究。
大学附属一级创伤中心。
2008 年 1 月 1 日至 2011 年 12 月 31 日期间入住 ICU 72 小时内被诊断为严重急性呼吸窘迫综合征的患者。
无。
从病历中提取数据，包括人口统计学和临床变量、住院和 ICU 住院时间、出院去向和住院费用。患者水平数据与华盛顿州死亡登记处相关联。采用 Kaplan-Meier 方法和 Cox 比例风险模型估计生存和风险比。确定了符合研究纳入标准的 428 名患者；其中 62 名（14%）开始接受抢救治疗。在接受抢救治疗和常规治疗的患者中，入院时的 PaO2/FIO2 比值相当，但在接受抢救治疗的患者中，72 小时时明显较低（54 ± 17 对 69 ± 17 mmHg；p < 0.01）。对于整个队列，3 年估计生存率为 55%（95%CI，51-61%）。在 280 名医院幸存者（65%）中，3 年生存率为 85%（95%CI，80-89%）。与常规治疗相比，接受抢救治疗的患者住院死亡率的相对危险度高 68%（95%CI，8-162%；p = 0.02）。对于长期生存，与 ICU 入院后死亡的危险比为 1.56（95%CI，1.02-2.37；p = 0.04），比较抢救与常规治疗。
尽管院内死亡率较高，但存活至出院的严重急性呼吸窘迫综合征患者的长期生存情况相对较好。低氧血症恶化与抢救治疗的开始有关。接受抢救治疗的患者院内死亡率较高；然而，存活至出院的患者的长期生存率与其他急性呼吸窘迫综合征幸存者相当。
