Nagata Isao, Takei Tetsuhiro, Hatakeyama Junji, Toh Masafumi, Yamada Hiroyuki, Fujisawa Michiko
Intensive Care Unit, Yokohama City Minato Red Cross Hospital, 3-12-1, Shinyamashita, Naka-ku, Yokohama, Kanagawa, 231-8682, Japan.
JA Clin Rep. 2019 Nov 4;5(1):73. doi: 10.1186/s40981-019-0284-4.
Information on epidemiology of prolonged mechanical ventilation (PMV) patients in the acute care setting in Japan is totally lacking. We aimed to investigate clinical features, impact, and long-term outcomes of PMV patients.
This was a retrospective observational study conducted in a tertiary care hospital. Adult patients who were admitted to our intensive care unit (ICU) from April 2009 to March 2014 and required mechanical ventilation (MV) for ≥ 2 days were included. PMV was defined as having MV for ≥ 21 consecutive days.
Among 1282 MV patients, 93 (7.3%) required PMV, and median duration of MV was 37.0 days. Compared with the non-PMV patients, PMV patients had longer total ICU and high care unit (HCU) stay (34.0 vs. 7.0 days, p < 0.001), longer hospital stay (74.0 vs. 35.0 days, p < 0.001), and higher hospital mortality (54.8 vs. 21.4%, p < 0.001). In multivariable logistic regression analysis, emergency ICU admission and steroid use during MV were associated with PMV. The Kaplan-Meier curves for MV withdrawal and ICU/HCU discharge were almost identical. Among PMV patients, 52 (55.9%) died, 29 (31.2%) were successfully liberated from MV during hospitalization, and 12 (12.9%) still required MV at discharge.
In this investigation, 7.3% of the patients with MV required PMV. Most PMV patients were liberated from MV during hospitalization, while occupying critical care beds for an extended period. A nationwide survey is required to further elucidate the overall picture of PMV patients and to discuss whether specialized weaning centers to treat PMV patients are required in Japan.
日本急性护理环境中长时间机械通气（PMV）患者的流行病学信息完全缺失。我们旨在调查PMV患者的临床特征、影响及长期预后。
这是一项在三级护理医院进行的回顾性观察研究。纳入2009年4月至2014年3月入住我们重症监护病房（ICU）且需要机械通气（MV）≥2天的成年患者。PMV定义为连续机械通气≥21天。
在1282例MV患者中，93例（7.3%）需要PMV，MV的中位持续时间为37.0天。与非PMV患者相比，PMV患者在ICU和高护理单元（HCU）的总住院时间更长（34.0天对7.0天，p<0.001），住院时间更长（74.0天对35.0天，p<0.001），医院死亡率更高（54.8%对21.4%，p<0.001）。在多变量逻辑回归分析中，急诊ICU入院和MV期间使用类固醇与PMV相关。MV撤机和ICU/HCU出院的Kaplan-Meier曲线几乎相同。在PMV患者中，52例（55.9%）死亡，29例（31.2%）在住院期间成功脱机，12例（12.9%）出院时仍需要MV。
在本调查中，7.3%的MV患者需要PMV。大多数PMV患者在住院期间脱机，但长时间占用重症监护床位。需要进行全国性调查以进一步阐明PMV患者的总体情况，并讨论日本是否需要专门的脱机中心来治疗PMV患者。
