Hayman W R, Leuthner S R, Laventhal N T, Brousseau D C, Lagatta J M
Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI, USA.
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
J Perinatol. 2015 Dec;35(12):1020-6. doi: 10.1038/jp.2015.131. Epub 2015 Oct 15.
To compare the use of mechanical ventilation and hospital costs across ventilated patients of all ages, preterm through adults, in a nationally representative sample.
Secondary analysis of the 2009 Agency for Healthcare Research and Quality National Inpatient Sample.
A total of 1 107 563 (2.8%) patients received mechanical ventilation. For surviving ventilated patients, median costs for infants ⩽32 weeks' gestation were $51000 to $209 000, whereas median costs for older patients were lower from $17 000 to $25 000. For non-surviving ventilated patients, median costs were $27 000 to $39 000 except at the extremes of age; the median cost was $10 000 for <24 week newborns and $14 000 for 91+ year adults. Newborns of all gestational ages had a disproportionate share of hospital costs relative to their total volume.
Most intensive care unit resources at the extremes of age are not directed toward non-surviving patients. From a perinatal perspective, attention should be directed toward improving outcomes and reducing costs for all infants, not just at the earliest gestational ages.
在一个具有全国代表性的样本中，比较所有年龄段（从早产儿到成人）接受机械通气患者的机械通气使用情况和住院费用。
对2009年医疗保健研究与质量局全国住院患者样本进行二次分析。
共有1107563名（2.8%）患者接受了机械通气。对于存活的接受机械通气的患者，孕周≤32周的婴儿的中位费用为51000美元至209000美元，而老年患者的中位费用较低，为17000美元至25000美元。对于未存活的接受机械通气的患者，除了年龄极端情况外，中位费用为27000美元至39000美元；孕周<24周的新生儿中位费用为10000美元，91岁及以上成人中位费用为14000美元。所有孕周的新生儿相对于其总体数量而言，在住院费用中所占比例过高。
年龄极端情况下的大多数重症监护病房资源并非用于未存活患者。从围产期角度来看，应关注改善所有婴儿的预后并降低费用，而不仅仅是最早孕周的婴儿。
