Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Division of Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
J Palliat Med. 2020 Mar;23(3):401-405. doi: 10.1089/jpm.2018.0632. Epub 2019 Aug 1.
Older adults frequently report a preference to "trial" intubation and mechanical ventilation (MV) if faced with life-threatening respiratory failure. Understanding the anticipated outcome of unplanned MV is key to structuring a time-limited trial of treatment. To characterize the time-to-death (TTD) among adults 65 years of age and older, who undergo emergency intubation and MV. Retrospective cohort study. All patients 65 years of age and older, who underwent emergency department (ED) intubation from 2008 to 2015, from 417 hospitals were included. The primary outcome was TTD after emergency intubation. We identified 41,463 ED encounters. The median TTD was three days (interquartile range, IQR, 1-8). There was a statistically significant change in the median TTD by age decile, with the shortest TTD, two days, in the oldest age group ( < 0.001). TTD was shortest among those with myocardial infarction (one day, IQR 4) and sepsis (two days, IQR 5). Bivariate analysis comparing TTD by Charleston Comorbidity Index (CCI) revealed a trend of increasing TTD with increasing CCI score among decedents. Patients with a CCI of 0 had a median TTD of one day (IQR 4), whereas the median TTD among those with a CCI >4 was four days (IQR 9). In a large, nationally representative cohort of older adults undergoing ED intubation, the median time from intubation to death was short; however, the length of time between intubation and death varied considerably by principal diagnosis. This information will help guide providers' prognostication after emergency intubation and enhance serious illness conversations by informing expectations. Thirty-five percent of older adults die after ED intubation-most only survive two or three days after intubation.
老年人在面临危及生命的呼吸衰竭时，常表示倾向于“尝试”气管插管和机械通气（MV）。了解计划外 MV 的预期结果是制定限时治疗试验的关键。本研究旨在描述接受急诊插管和 MV 的 65 岁及以上成年人的死亡时间（TTD）。这是一项回顾性队列研究。纳入了 2008 年至 2015 年期间，417 家医院急诊科接受插管的所有 65 岁及以上的患者。主要结局是急诊插管后的 TTD。我们共确定了 41463 例 ED 就诊。TTD 的中位数为 3 天（四分位距，IQR，1-8）。TTD 的中位数随年龄的十位数变化而存在统计学显著差异，最年长组（ < 0.001）的 TTD 最短，为 2 天。TTD 在心肌梗死（1 天，IQR 4）和败血症（2 天，IQR 5）患者中最短。通过Charleston 合并症指数（CCI）比较 TTD 的双变量分析显示，死亡患者的 TTD 随 CCI 评分的增加而呈增加趋势。CCI 评分为 0 的患者的 TTD 中位数为 1 天（IQR 4），而 CCI 评分大于 4 的患者的 TTD 中位数为 4 天（IQR 9）。在一项大型、具有全国代表性的接受 ED 插管的老年患者队列研究中，从插管到死亡的中位时间较短；然而，插管到死亡之间的时间长度因主要诊断而异。这些信息将有助于指导提供者在急诊插管后进行预后，并通过告知预期来加强严重疾病的沟通。35%的老年人在 ED 插管后死亡——大多数人在插管后仅存活 2 到 3 天。
