Khatib Khalid Ismail, Dixit Subhal Bhalchandra, Joshi Mukund Manohar
Department of Medicine, SKN Medical College, Pune, Maharashtra, India.
Intensive Care Unit, MJM Hospital, Pune, Maharashtra, India.
Int J Crit Illn Inj Sci. 2018 Jan-Mar;8(1):9-16. doi: 10.4103/IJCIIS.IJCIIS_41_17.
Characteristics of patients admitted to intensive care units with respiratory failure (RF) and undergoing mechanical ventilation (MV) have been described for particular indications and diseases, but there are few studies in the general Intensive Care Unit (ICU) population and even lesser from developing countries.
This study aims to study clinical characteristics, outcomes, and factors affecting outcomes in adult patients with RF on MV admitted to ICU.
A retrospective study of medical records of all patients admitted to ICU between January 1, 2015, and March 31, 2016. Patients receiving MV for more than 6 h were included in the study. Patients younger than 12 years were excluded. Data were recorded of all patients receiving MV during this period regarding demographics, indications for MV, type and characteristics of ventilation, concomitant complications and treatment, and outcomes. Data were recorded at the initiation of MV and daily all throughout the course of MV. The main outcome measure was all-cause mortality at the end of ICU stay.
Of the 500 patients admitted to the ICU during the period of the study, a total of 122 patients received MV (and were included in study) for mean (standard deviation [SD]) duration of 4 (3.4) days. The mean (SD) stay in ICU and hospital was 4.49 (3.52) and 6.4 (3.6), respectively. Overall mortality for the unselected general ICU patients on MV was 67.21% while that for ARDS patients was 76.1%. The main factors independently associated with increased mortality were (i) pre-MV factors: age, Apache II scores, heart failure (odds ratio [OR], 1.42; 95% confidence interval [CI], 0.54-3.73; < 0.001); (ii) patient management factors: positive end-expiratory pressure (OR, 2.69; 95% CI, 0.84-8.61; < 0.001); (iii) Factors occurring over the course of MV: PaO/FiO ratio < 100 (OR, 1.66; 95% CI, 0.67-4.11; < 0.001) and development of renal failure (OR, 2.33; 95% CI, 2.05-2.42; < 0.001) and hepatic failure (OR, 2.07; 95% CI, 1.91-2.24; < 0.001) after initiation of MV.
Outcomes of patients undergoing MV are dependent on various factors (including patient demographics, nature of associated morbidity, characteristics of the MV received, and conditions developing over course of MV) and these factors may be present before or develop after initiation of MV.
针对特定适应症和疾病，已对入住重症监护病房（ICU）并接受机械通气（MV）的呼吸衰竭（RF）患者的特征进行了描述，但针对普通ICU人群的研究较少，来自发展中国家的研究更少。
本研究旨在探讨入住ICU并接受MV的成年RF患者的临床特征、结局及影响结局的因素。
对2015年1月1日至2016年3月31日期间入住ICU的所有患者的病历进行回顾性研究。接受MV超过6小时的患者纳入研究。排除年龄小于12岁的患者。记录此期间所有接受MV患者的人口统计学资料、MV适应症、通气类型和特征、伴随并发症及治疗情况以及结局。在MV开始时及MV全过程每天记录数据。主要结局指标为ICU住院结束时的全因死亡率。
在研究期间入住ICU的500例患者中，共有122例患者接受了MV（并纳入研究），平均（标准差[SD]）持续时间为4（3.4）天。在ICU和医院的平均（SD）住院时间分别为4.49（3.52）天和6.4（3.6）天。未筛选的接受MV的普通ICU患者的总体死亡率为67.21%，而急性呼吸窘迫综合征（ARDS）患者的死亡率为76.1%。与死亡率增加独立相关的主要因素为：（i）MV前因素：年龄、急性生理与慢性健康状况评分系统II（Apache II）评分、心力衰竭（比值比[OR]，1.42；95%置信区间[CI]，0.54 - 3.73；<0.001）；（ii）患者管理因素：呼气末正压（OR，2.69；95% CI，0.84 - 8.61；<0.001）；（iii）MV过程中出现的因素：动脉血氧分压/吸入氧分数值（PaO/FiO）<100（OR，1.66；95% CI，0.67 - 4.11；<0.001）以及MV开始后出现肾衰竭（OR，2.33；95% CI，2.05 - 2.42；<0.001）和肝衰竭（OR，2.07；95% CI，1.91 - 2.24；<0.001）。
接受MV患者的结局取决于多种因素（包括患者人口统计学资料、相关发病情况的性质、接受的MV特征以及MV过程中出现的情况），这些因素可能在MV开始前就已存在或在MV开始后出现。
