Depuydt P, Oeyen S, De Smet S, De Raedt S, Benoit D, Decruyenaere J, Derom E
Intensive Care Department, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium.
Heymans Institute of Pharmacology, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium.
BMC Pulm Med. 2016 Sep 27;16(1):133. doi: 10.1186/s12890-016-0295-0.
Long-term outcome and quality of life (QOL) in patients requiring prolonged mechanical ventilation after failure to wean in the ICU is scarcely documented. We aimed to evaluate long-term survival and QOL in patients discharged from the ICU with a tracheostomy for difficult weaning, and with or without ventilator dependency at ICU discharge.
We retrospectively investigated post-ICU trajectories and survival in patients requiring tracheostomy for difficult weaning admitted to the medical ICU of a tertiary center between 1999 and 2013, discriminating between patients who were ventilator dependent or were weaned at ICU discharge. In 2014, a QOL assessment was done in survivors with the use of the Short Form Health Survey (SF-36) and the Severe Respiratory Insufficiency questionnaire.
A total of 114 patients was included, of whom 59 were ventilator dependent and 55 were weaned at ICU discharge. One-year survival rates were 73 % and 69 %, respectively. Overall QOL scores for physical functioning were low, and not significantly different between patients ventilated and those weaned at ICU discharge; scores for social functioning and mental health were less below norm and similar between both groups.
Long-term survival in patients discharged from the ICU with tracheostomy and ventilator dependency after failure to wean was not significantly different from that of patients with tracheostomy and weaned at ICU discharge. Despite the physical QOL scores being low in both groups, mental QOL was acceptable. Given the intrinsic limitations of this retrospective study, prospective and preferentially multicenter studies are required to confirm these preliminary results.
在重症监护病房（ICU）中，撤机失败后需要长期机械通气的患者的长期预后和生活质量（QOL）鲜有记录。我们旨在评估因撤机困难而接受气管造口术并在ICU出院时伴有或不伴有呼吸机依赖的患者的长期生存率和生活质量。
我们回顾性调查了1999年至2013年间在一家三级中心的内科ICU因撤机困难而需要气管造口术的患者的ICU后病程和生存率，区分在ICU出院时依赖呼吸机或已撤机的患者。2014年，使用简短健康调查问卷（SF-36）和严重呼吸功能不全问卷对幸存者进行了生活质量评估。
共纳入114例患者，其中59例依赖呼吸机，55例在ICU出院时已撤机。一年生存率分别为73%和69%。身体功能的总体生活质量评分较低，在ICU出院时使用呼吸机的患者和已撤机的患者之间无显著差异；社会功能和心理健康评分略低于正常水平，两组之间相似。
因撤机失败而在ICU出院时带有气管造口术和呼吸机依赖的患者的长期生存率与在ICU出院时已撤机的气管造口术患者相比无显著差异。尽管两组的身体生活质量评分都很低，但心理生活质量是可以接受的。鉴于这项回顾性研究的固有局限性，需要进行前瞻性研究，最好是多中心研究来证实这些初步结果。
