Ouchi Kei, Lo Bello Josephine, Moseley Edward, Lindvall Charlotta
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA; Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA.
University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
J Pain Symptom Manage. 2020 Nov;60(5):1019-1026. doi: 10.1016/j.jpainsymman.2020.06.004. Epub 2020 Jun 12.
Emergent mechanical ventilation represents an important inflection point in seriously ill older adults' illness trajectories. Data are lacking on the long-term prognosis after surviving mechanical ventilation to inform shared decision making in serious illness conversations.
Describe the long-term prognosis of older adults who survive emergency mechanical ventilation to inform shared decision making.
This is a retrospective cohort study from a single-center intensive care unit in an academic, urban, and tertiary care medical center. We included adults aged 75 years and older consecutively admitted with mechanical ventilation between 2008 and 2012 in the Multiparameter Intelligent Monitoring of Intensive Care III database. We excluded patients who were electively admitted. Our primary outcome was the long-term prognosis after leaving the hospital stratified by discharge location. Our secondary outcome was the frequency of documented serious illness conversations within 48 hours of hospitalization recommended by the National Quality Forum.
We identified 415 patients (454 hospital admissions) consecutively admitted to the intensive care unit. The median age was 82.6 years, 54.0% were female, 78.2% were white, non-Hispanic, and in-hospital mortality rate was 36.6%. Among the survivors, the median survival after hospital discharge was 163.5 days (interquartile range 37.5-476.8). Only 49.1% of patients had documented serious illness conversations within 48 hours of hospitalization. About 63.4% of patients (59 of 93) who were discharged to long-term acute care hospitals died by six months.
This study demonstrated the long-term prognosis of older adults who underwent emergent mechanical ventilation. These data could be used to inform shared decision making in serious illness conversations.
紧急机械通气是重症老年患者疾病轨迹中的一个重要转折点。目前缺乏机械通气存活后的长期预后数据，无法为重症疾病讨论中的共同决策提供参考。
描述紧急机械通气存活的老年患者的长期预后，为共同决策提供参考。
这是一项来自学术性城市三级医疗中心单中心重症监护病房的回顾性队列研究。我们纳入了2008年至2012年期间在多参数智能重症监护III数据库中连续接受机械通气的75岁及以上成年人。我们排除了择期入院的患者。我们的主要结局是出院后按出院地点分层的长期预后。我们的次要结局是国家质量论坛建议的住院48小时内记录的重症疾病讨论的频率。
我们确定了415例连续入住重症监护病房的患者（454次住院）。中位年龄为82.6岁，54.0%为女性，78.2%为非西班牙裔白人，住院死亡率为36.6%。在幸存者中，出院后的中位生存期为163.5天（四分位间距37.5 - 476.8）。只有49.1%的患者在住院48小时内有记录的重症疾病讨论。约63.4%（93例中的59例）出院至长期急性护理医院的患者在6个月内死亡。
本研究展示了接受紧急机械通气的老年患者的长期预后。这些数据可用于为重症疾病讨论中的共同决策提供参考。
