老年患者从重症监护病房和呼吸机中解脱后的重症监护病房呼吸衰竭：国家早期预警评分对重症监护病房出院的预测价值。

Post-intensive care unit respiratory failure in older patients liberated from intensive care unit and ventilator: The predictive value of the National Early Warning Score on intensive care unit discharge.

机构信息

Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.

出版信息

Geriatr Gerontol Int. 2019 Apr;19(4):317-322. doi: 10.1111/ggi.13626. Epub 2019 Feb 20.

DOI:10.1111/ggi.13626

PMID:30788891

Abstract

AIM

The older adult population is continuously growing worldwide and there is increasing use of medical recourse in older patients, especially for those requiring intensive care unit (ICU) care and mechanical ventilation (MV). The present study aimed to investigate the burden and predictors of post-ICU respiratory failure in older ICU patients weaned from MV.

METHODS

In the present retrospective study, older ICU patients aged ≥60 years, who were successfully weaned from MV and discharged to the general ward from the ICU of Taipei Veterans General Hospital, Taipei, Taiwan, in 2011, were included. Biomarkers on ICU discharge, as well as the National Early Warning Score (NEWS) were recorded and calculated. The outcome measure was post-ICU respiratory failure before day 14 (PIRF-14) requiring reinstitution of MV. Logistical regression was used to assess the predictors for PIRF-14.

RESULTS

Of 272 patients included, 23 (8.5%) developed PIRF-14. The post-ICU in-hospital mortality rates were 47.8% and 6.8% in patients with and without PIRF-14 (adjusted OR 12.597, 95% CI 4.368-36.331). In a multivariate analysis, the levels of NEWS and hemoglobin on ICU discharge were independent predictors for PIRF-14 (adjusted OR 1.273, 95% CI 1.076-1.507 and 0.645, 95% CI 0.474-0.879). In particular, patients with a NEWS of ≥10 and subsequent PIRF-14 had a 15-fold increased risk of mortality as compared with those without both factors (adjusted OR 15.418, 95% CI 4.344-54.720).

CONCLUSIONS

PIRF-14 is associated with high mortality in older ICU patients, and NEWS is a significant predictor for PIRF-14, which could be used to early identify patients at risk of post-ICU respiratory failure in the specific population. Geriatr Gerontol Int 2019; 19: 317-322.

摘要

目的

全球老年人口不断增加，老年患者对医疗资源的使用也在不断增加，特别是需要重症监护病房（ICU）护理和机械通气（MV）的患者。本研究旨在调查从 MV 撤机并转入普通病房的老年 ICU 患者继发 ICU 呼吸衰竭的负担和预测因素。

方法

本回顾性研究纳入了 2011 年从台湾台北荣民总医院 ICU 撤机并转入普通病房的年龄≥60 岁的老年 ICU 患者。记录并计算 ICU 出院时的生物标志物以及国家早期预警评分（NEWS）。主要转归为 14 天内继发 ICU 呼吸衰竭（PIRF-14），需要重新建立 MV。采用逻辑回归评估 PIRF-14 的预测因素。

结果

272 例患者中，23 例（8.5%）发生 PIRF-14。PIRF-14 患者 ICU 院内死亡率为 47.8%和 6.8%（校正比值比 12.597，95%CI 4.368-36.331）。多变量分析显示，ICU 出院时 NEWS 和血红蛋白水平是 PIRF-14 的独立预测因素（校正比值比 1.273，95%CI 1.076-1.507 和 0.645，95%CI 0.474-0.879）。特别是 NEWS≥10 且随后发生 PIRF-14 的患者与无这两个因素的患者相比，死亡风险增加了 15 倍（校正比值比 15.418，95%CI 4.344-54.720）。