Vora Chakor S, Karnik Niteen D, Gupta Vishal, Nadkar Milind Y, Shetye Jaimala V
Resident.
Professor and I/C MNICU.
J Assoc Physicians India. 2015 Oct;63(10):14-9.
An increasing number of patients require mechanical ventilation and there has been a proportional increase in patients needing prolonged mechanical ventilation (ventilated for ≥ 21 days, for atleast 6 hours per day). It accounts for about 10% of all mechanically ventilated patients. Although these patients represent a smaller proportion of intensive care unit (ICU) patients, they consume substantial ICU resources. We studied etiology, metabolic and clinical profile, complications and outcome of these patients.
This was a prospective observational study in the medical ICUs of a tertiary hospital over 18 months. All patients above 12 years of age requiring prolonged invasive mechanical ventilation were recruited. Detailed clinical and laboratory records were noted. Sequential Organ Failure Assessment (SOFA) score was calculated on admission.
Of a total 1150 patients who were admitted in ICU during study duration, 34.5% (n= 397) needed mechanical ventilation and 3.91% (n=45) required prolonged mechanical ventilation. Most common patient subsets were: acute inflammatory demyelinating polyneuropathy (AIDP) 28.50% (n=13), cerebro-vascular accident (CVA): 17.30% (n=8), tetanus 8.60% (n=4) and acute respiratory distress syndrome (ARDS) 6.50% (n=3). The mean age of patients was 32 years. Electrolyte imbalances observed were hypocalcaemia (84.44%), hypomagnesaemia (40.9%), hypokalemia (31.11%) and hypophosphatemia (23.8%). Ventilator-associated pneumonia (VAP) (53.33%) was the most frequent complication, followed by decubitus ulcers (40%) and deep vein thrombosis (8.89%). Mean duration of ICU stay was 57.02 days ± 44.73 days. Twenty six out of 45 patients (57.75%) were successfully weaned off ventilator support and discharged from the hospital. The SOFA score of patients who survived (mean 2.15) was lesser than that of patients who expired (mean 2.89) (p= 0.36, ns).
The incidence of prolonged mechanical ventilation in our study was 3.91% of total 1150 ICU admissions and 11.3% of the 397 patients requiring invasive mechanical ventilation. AIDP, CVA, tetanus and ARDS were the most common diagnoses. Survival in the study population was 57.75%. VAP was the most common complication. High incidence of hypocalcaemia, hypomagnesaemia, hypokalemia and hypophosphatemia was noted in patients requiring prolonged mechanical ventilation.
需要机械通气的患者数量不断增加，需要长期机械通气（通气≥21天，每天至少6小时）的患者也相应增加。这部分患者约占所有机械通气患者的10%。尽管这些患者在重症监护病房（ICU）患者中所占比例较小，但他们消耗了大量的ICU资源。我们研究了这些患者的病因、代谢和临床特征、并发症及预后。
这是一项在一家三级医院的医学ICU进行的为期18个月的前瞻性观察研究。招募所有年龄在12岁以上需要长期有创机械通气的患者。记录详细的临床和实验室记录。入院时计算序贯器官衰竭评估（SOFA）评分。
在研究期间入住ICU的1150例患者中，34.5%（n = 397）需要机械通气，3.91%（n = 45）需要长期机械通气。最常见的患者亚组为：急性炎症性脱髓鞘性多发性神经病（AIDP）28.50%（n = 13）、脑血管意外（CVA）：17.30%（n = 8）、破伤风8.60%（n = 4）和急性呼吸窘迫综合征（ARDS）6.50%（n = 3）。患者的平均年龄为32岁。观察到的电解质失衡有低钙血症（84.44%）、低镁血症（40.9%）、低钾血症（31.11%）和低磷血症（23.8%）。呼吸机相关性肺炎（VAP）（53.33%）是最常见的并发症，其次是压疮（40%）和深静脉血栓形成（8.89%）。ICU平均住院时间为57.02天±44.73天。45例患者中有26例（57.75%）成功脱机并出院。存活患者的SOFA评分（平均2.15）低于死亡患者（平均2.89）（p = 0.36，无统计学意义）。
在我们的研究中，长期机械通气的发生率占1150例ICU入院患者总数的3.91%，占397例需要有创机械通气患者的11.3%。AIDP、CVA、破伤风和ARDS是最常见的诊断。研究人群的存活率为57.75%。VAP是最常见的并发症。需要长期机械通气的患者中低钙血症、低镁血症、低钾血症和低磷血症的发生率较高。
