重症监护中的胸腔积液结局：大型临床数据库分析。

Pleural Effusion Outcomes in Intensive Care: Analysis of a Large Clinical Database.

机构信息

Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.

Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA, USA.

出版信息

J Intensive Care Med. 2020 Jan;35(1):48-54. doi: 10.1177/0885066619872449. Epub 2019 Sep 4.

DOI:10.1177/0885066619872449

PMID:31640451

Abstract

BACKGROUND

Pleural effusions are common in critically ill patients. However, the management of pleural fluid on relevant clinical outcomes is poorly studied. We evaluated the impact of pleural effusion in the intensive care unit (ICU).

METHODS

A large observational ICU database Multiparameter Intelligent Monitoring in Intensive Care III was utilized. Analyses used matched patients with the same admission diagnosis, age, gender, and disease severity.

RESULTS

Of 50 765, 3897 (7.7%) of critically ill adult patients had pleural effusions. Compared to patients without effusion, patients with effusion had higher in-hospital (38.7% vs 31.3%, < .0001), 1-month (43.1% vs 36.1%, < .0001), 6-month (63.6% vs 55.7%, < .0001), and 1-year mortality (73.8% vs 66.1%, < .0001), as well as increased length of hospital stay (17.6 vs 12.7 days, < .0001), ICU stay (7.3 vs 5.1 days, < .0001), need for mechanical ventilation (63.1% vs 55.7%, < .0001), and duration of mechanical ventilation (8.7 vs 6.3 days, < .0001). A total of 1503 patients (38.6%) underwent pleural fluid drainage. Patients in the drainage group had higher in-hospital (43.9% vs 35.4%, = .0002), 1-month (47.7% vs 39.7%, = .0005), 6-month (67.1% vs 61.8%, = .0161), and 1-year mortality (77.1% vs 72.1%, = .0147), as well as increased lengths of hospital stay (22.1 vs 16.0 days, < .0001), ICU stay (9.2d vs 6.4 days, < .0001), and duration of mechanical ventilation (11.7 vs 7.1 days, < .0001).

CONCLUSIONS

The presence of a pleural effusion was associated with increased mortality in critically ill patients regardless of disease severity. Drainage of pleural effusion was associated with worse outcomes in a large, heterogeneous cohort of ICU patients.

摘要

背景

胸腔积液在重症患者中很常见。然而，胸腔积液对相关临床结局的管理研究甚少。本研究评估了胸腔积液对重症监护病房（ICU）的影响。

方法

利用大型观察性 ICU 数据库 Multiparameter Intelligent Monitoring in Intensive Care III 进行分析。分析采用相同入院诊断、年龄、性别和疾病严重程度的匹配患者。

结果

在 50765 例重症成年患者中，有 3897 例（7.7%）存在胸腔积液。与无胸腔积液的患者相比，有胸腔积液的患者院内（38.7%比 31.3%，<0.0001）、1 个月（43.1%比 36.1%，<0.0001）、6 个月（63.6%比 55.7%，<0.0001）和 1 年死亡率（73.8%比 66.1%，<0.0001）更高，住院时间（17.6 天比 12.7 天，<0.0001）、ICU 住院时间（7.3 天比 5.1 天，<0.0001）、机械通气需求（63.1%比 55.7%，<0.0001）和机械通气时间（8.7 天比 6.3 天，<0.0001）更长。共有 1503 例患者（38.6%）接受了胸腔积液引流。引流组患者院内（43.9%比 35.4%，=0.0002）、1 个月（47.7%比 39.7%，=0.0005）、6 个月（67.1%比 61.8%，=0.0161）和 1 年死亡率（77.1%比 72.1%，=0.0147）更高，住院时间（22.1 天比 16.0 天，<0.0001）、ICU 住院时间（9.2 天比 6.4 天，<0.0001）和机械通气时间（11.7 天比 7.1 天，<0.0001）更长。