1 Clinical Outcomes Research Group, Coler Rehabilitation and Nursing Care Center, New York, NY, USA.
2 Division of Geriatrics and Gerontology, Weill Cornell Medical College, New York, NY, USA.
J Intensive Care Med. 2018 Sep;33(9):527-535. doi: 10.1177/0885066616683669. Epub 2016 Dec 14.
To investigate the effects of the reinstitution of continuous mechanical ventilator support of >21 days in 370 prolonged mechanical ventilation (PMV) patients, all free from ventilator support for ≥5 days.
Four groups were formed based on the time and number of PMV reinstitutions and compared (group A: reinstitutions within 28 days, n = 51; group B: a single reinstitution after 28 days, n = 53; group C: multiple reinstitutions after 28 days, n = 52; and group D: no known reinstitutions, n = 214).
Of the 370 patients, 156 (42%) required PMV reinstitutions. Most reinstitutions occurred within 7 months: 51 (33%) of the 156 patients within 28 days and 49 (31%) within the next 6 months. Group comparisons revealed a progression of outcomes from group A, the worst, to group D, the best, with groups B and C having intermediate but significantly different values. Decannulation was associated with an 88% decreased risk of PMV reinstitution and a 43% lower risk of death (all P < .001).
Prolonged mechanical ventilation reinstitution rates were high, with most occurring within 7 months of freedom from MV. In general, the longer the period of ventilator freedom, the less the likelihood of a PMV reinstitution. The identification of 4 distinct PMV groups of patients by time and number of reinstitutions added useful prognostic information. Since PMV reinstitutions within 28 days lead to permanent MV support, >28 days of ventilator freedom provided an optimal cut point for assessing the likelihood of again requiring PMV.
研究 370 例长时间机械通气（PMV）患者中，5 天以上无呼吸机支持的 370 例患者重新开始持续机械通气支持＞21 天的效果。
根据 PMV 重新开始的时间和次数将 4 组患者进行分组并进行比较（A 组：28 天内重新开始，n=51；B 组：28 天后单次重新开始，n=53；C 组：28 天后多次重新开始，n=52；D 组：无已知重新开始，n=214）。
370 例患者中有 156 例（42%）需要 PMV 重新开始。大多数重新开始发生在 7 个月内：156 例患者中有 51 例（33%）在 28 天内，49 例（31%）在接下来的 6 个月内。组间比较显示，结局从最差的 A 组逐渐改善到最好的 D 组，B 组和 C 组的结果处于中间，但差异有统计学意义。脱机与 PMV 重新开始的风险降低 88%和死亡风险降低 43%相关（均 P＜.001）。
长时间机械通气重新开始的比例较高，大多数发生在无 MV 自由后 7 个月内。一般来说，呼吸机自由时间越长，重新开始 PMV 的可能性越低。通过时间和重新开始次数将患者分为 4 个不同的 PMV 组，提供了有用的预后信息。由于 28 天内重新开始导致永久 MV 支持，因此＞28 天的呼吸机自由提供了评估再次需要 PMV 的可能性的最佳临界点。
