Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America; Department of Health Science Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America.
Int J Cardiol. 2019 Jun 15;285:6-10. doi: 10.1016/j.ijcard.2019.03.008. Epub 2019 Mar 6.
There are limited data on prolonged invasive mechanical ventilation (IMV) and tracheostomy use in intubated acute myocardial infarction with cardiogenic shock (AMI-CS) patients.
Using the National Inpatient Sample, all admissions with AMI-CS requiring IMV between January 1, 2000, and December 31, 2014, were included. Prolonged IMV was defined as IMV use >96 h. Outcomes of interest included temporal trends in use of prolonged IMV and tracheostomy, in-hospital mortality, and resource utilization.
In this 15-year period, 185,589 intubated AMI-CS admissions met the inclusion criteria. Prolonged IMV (>96 h) and tracheostomy use were noted in 68,544 (36.9%) and 10,645 (5.7%), respectively. Prolonged IMV and tracheostomy were used more commonly in younger patients. The cohort with prolonged IMV had higher organ failure and greater use of cardiac and non-cardiac organ support. Temporal trends showed a decline in prolonged IMV (adjusted odds ratio {aOR} 0.61 [95% confidence interval {CI} 0.57-0.65]) and tracheostomy use (aOR 0.80 [95% CI 0.70-0.90]) in 2014 compared to 2000. Prolonged IMV (aOR 0.45 [95% CI 0.44-0.47]; p < 0.001) and tracheostomy (aOR 0.28 [95% CI 0.27-0.29]; p < 0.001) were associated with lower in-hospital mortality with a decreasing trend between 2000 and 2014 in intubated AMI-CS admissions. Patients with prolonged IMV and tracheostomy use had nearly three-fold higher health care costs, and four-fold longer hospital stays.
In this cohort of intubated AMI-CS admissions, prolonged IMV and tracheostomy showed a temporal decrease between 2000 and 2014. Prolonged IMV and tracheostomy use was associated with high resource utilization.
在接受有创机械通气（IMV）并进行气管切开术的急性心肌梗死合并心源性休克（AMI-CS）患者中，关于延长 IMV 时间和气管切开术使用的数据有限。
利用国家住院患者样本，纳入 2000 年 1 月 1 日至 2014 年 12 月 31 日期间需要 IMV 的 AMI-CS 并接受插管治疗的所有住院患者。将延长 IMV 定义为 IMV 使用时间＞96 小时。主要观察指标为延长 IMV 和气管切开术使用的时间趋势、院内死亡率以及资源利用情况。
在这 15 年期间，共有 185589 例接受插管治疗的 AMI-CS 患者符合纳入标准。分别有 68544 例（36.9%）和 10645 例（5.7%）患者接受了延长 IMV（＞96 小时）和气管切开术治疗。年轻患者中更常使用延长 IMV 和气管切开术。与未接受延长 IMV 治疗的患者相比，接受延长 IMV 治疗的患者器官衰竭发生率更高，且更常使用心脏和非心脏器官支持治疗。时间趋势显示，与 2000 年相比，2014 年延长 IMV（调整比值比[aOR]0.61[95%置信区间{CI}0.57-0.65]）和气管切开术（aOR 0.80[95%CI 0.70-0.90]）的使用率下降。延长 IMV（aOR 0.45[95%CI 0.44-0.47]；p＜0.001）和气管切开术（aOR 0.28[95%CI 0.27-0.29]；p＜0.001）与更低的院内死亡率相关，2000 年至 2014 年，接受插管治疗的 AMI-CS 患者的死亡率呈下降趋势。接受延长 IMV 和气管切开术治疗的患者的医疗保健费用几乎增加了三倍，住院时间延长了四倍。
在本项插管治疗的 AMI-CS 患者队列中，2000 年至 2014 年间，延长 IMV 和气管切开术的使用时间呈下降趋势。延长 IMV 和气管切开术的使用与高资源利用率相关。
