Sison Stephanie M, Sivakumar Gayathri K, Caufield-Noll Christine, Greenough William B, Oh Esther S, Galiatsatos Panagis
Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Heliyon. 2021 Feb;7(2):e06230. doi: 10.1016/j.heliyon.2021.e06230. Epub 2021 Feb 13.
To determine the outcomes of chronically ventilated patients outside the setting of intensive care units.
Systematic review.
Studies evaluating patients on chronic invasive mechanical ventilation in different care settings.
A systematic literature search of the PubMed, Embase, Cochrane Library, CINAHL (EBSCOhost), LILACS and Scopus databases from inception to March 27, 2020. Studies reporting mortality outcomes of patients ≥18 years of age on chronic invasive mechanical ventilation in intensive care units and other care settings were eligible for inclusion.
Sixty studies were included in the systematic review. Mortality rates ranged from 13.7% to 77.8% in ICUs (n = 17 studies), 7.8%-51.0% in non-ICUs including step-down units and inpatient wards (n = 26 studies), and 12.0%-91.8% in home or nursing home settings (n = 19 studies). Age was associated with mortality in all care settings. Weaning rates ranged from 10.0% to 78.2% across non-ICU studies. Studies reporting weaning as their primary outcome demonstrated higher success rates in weaning. Home care studies reported low incidences of ventilator failure. None of the studies reported ventilator malfunction as the primary cause of death.
Mortality outcomes across various settings were disparate due to methodological and clinical heterogeneity among studies. However, there is evidence to suggest non-ICU venues of care as a comparable alternative to ICUs for stable, chronically ventilated patients, with the additional benefit of providing specialized weaning programs. By synthesizing the global data on managing chronically ventilated patients in various care settings, this study provides health care systems and providers alternative venue options for the delivery of prolonged ventilatory care in the context of limited ICU resources.
确定重症监护病房以外的长期通气患者的治疗结果。
系统评价。
评估不同护理环境下慢性有创机械通气患者的研究。
对PubMed、Embase、Cochrane图书馆、CINAHL（EBSCOhost）、LILACS和Scopus数据库进行系统文献检索，检索时间从数据库建立至2020年3月27日。纳入报告重症监护病房及其他护理环境中≥18岁慢性有创机械通气患者死亡率结果的研究。
系统评价纳入了60项研究。重症监护病房的死亡率在13.7%至77.8%之间（n = 17项研究），非重症监护病房（包括降级病房和住院病房）的死亡率在7.8%至51.0%之间（n = 26项研究），家庭或养老院环境中的死亡率在12.0%至91.8%之间（n = 19项研究）。在所有护理环境中，年龄与死亡率相关。非重症监护病房研究的撤机成功率在10.0%至78.2%之间。将撤机作为主要结局的研究显示撤机成功率更高。家庭护理研究报告的呼吸机故障发生率较低。没有研究报告呼吸机故障是主要死因。
由于研究之间存在方法学和临床异质性，不同环境下的死亡率结果存在差异。然而，有证据表明，对于稳定的长期通气患者，非重症监护病房护理场所可作为重症监护病房的可比替代方案，还能提供专门的撤机计划。通过综合全球不同护理环境下管理长期通气患者的数据，本研究为卫生保健系统和提供者在重症监护病房资源有限的情况下提供了延长通气护理的替代场所选择。
