Shen Jay J, Ko Eunjeong, Kim Pearl, Kim Sun Jung, Lee Yong-Jae, Lee Jae-Hoon, Yoo Ji Won
1 Department of Healthcare Administration and Policy, University of Nevada Las Vegas, Las Vegas, NV, USA.
2 School of Social Work, San Diego State University, San Diego, CA, USA.
J Palliat Care. 2018 Jul;33(3):159-166. doi: 10.1177/0825859718777375. Epub 2018 May 29.
Little is known regarding the extent to which dying patients with chronic obstructive pulmonary disease (COPD) receive life-sustaining procedures and palliative care in US hospitals. We examined temporal trends and the impact of palliative care on the use of life-sustaining procedures in this population.
A retrospective nationwide cohort analysis was performed using weighted National Inpatient Sample (NIS) data obtained from 2010 to 2014. Decedents ≥18 years of age at the time of death and with a principal diagnosis of COPD were included. We examined the receipt of life-sustaining procedures, defined as1 ventilation (intubation, mechanical ventilation, and noninvasive ventilation),2 vasopressor use (infusion and intravascular monitoring),3 nutrition (enteral and parenteral infusion of concentrated nutrition),4 dialysis, and5 cardiopulmonary resuscitation as well as palliative care consultation and do not resuscitate (DNR). We used compound annual growth rates (CAGRs) and the Rao-Scott correction of the χ2 statistic to determine the statistical significance of temporal trends of life-sustaining procedures, palliative care utilization, and DNR status.
Among 37 312 324 hospitalizations, 38 425 patients were examined. The CAGRs of life-sustaining procedures were 6.61% and -9.73% among patients who underwent multiple procedures and patients who did not undergo any procedure, respectively (both P < .001). The CAGRs of palliative consultation and DNR were 5.25% and 36.62%, respectively (both P < .001).
Among adults with COPD dying in US hospitals between 2010 and 2014, the utilization of life-sustaining procedures, palliative care, and DNR status increased.
在美国医院中，对于慢性阻塞性肺疾病（COPD）临终患者接受维持生命治疗措施和姑息治疗的程度知之甚少。我们研究了这一人群中维持生命治疗措施使用情况的时间趋势以及姑息治疗的影响。
使用2010年至2014年获得的加权全国住院患者样本（NIS）数据进行全国性回顾性队列分析。纳入死亡时年龄≥18岁且主要诊断为COPD的死者。我们研究了维持生命治疗措施的接受情况，定义为：1.通气（插管、机械通气和无创通气）；2.使用血管活性药物（输注和血管内监测）；3.营养支持（肠内和肠外输注浓缩营养）；4.透析；5.心肺复苏，以及姑息治疗会诊和不进行心肺复苏（DNR）。我们使用复合年增长率（CAGRs）和χ2统计量的Rao-Scott校正来确定维持生命治疗措施、姑息治疗利用情况和DNR状态时间趋势的统计学意义。
在37312324例住院病例中，对38425例患者进行了检查。接受多种治疗措施的患者和未接受任何治疗措施的患者中，维持生命治疗措施的复合年增长率分别为6.61%和-9.73%（均P<.001）。姑息治疗会诊和DNR的复合年增长率分别为5.25%和36.62%（均P<.001）。
在2010年至2014年间在美国医院死亡的成年COPD患者中，维持生命治疗措施、姑息治疗的使用以及DNR状态均有所增加。
