Park Sojung, Kim Won-Young, Baek Moon Seong
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Int J Gen Med. 2022 Feb 16;15:1637-1646. doi: 10.2147/IJGM.S349249. eCollection 2022.
Pleural effusions are common in mechanically ventilated patients. However, the risk factors for poor outcomes after pleural drainage are poorly understood. This study aimed to identify factors that were associated with in-hospital mortality among mechanically ventilated patients who underwent pleural drainage.
This retrospective study evaluated 82 consecutive patients who required chest tubes during mechanical ventilation at two university-affiliated hospitals in Korea between January 2015 and June 2020.
The median age was 76 years (interquartile range [IQR]: 64-84 years), and the median SOFA score was 11 (IQR: 7-13). Intensive care unit admission was most commonly because of pneumonia (n = 44, 53.7%) and 60 patients (77.9%) had exudative pleural effusions. During pleural drainage, the PaO/FiO was 210 (IQR: 153-253); 45 patients (54.9%) were receiving vasopressors, and 31 patients (37.8%) were receiving continuous renal replacement therapy (CRRT). The multivariable regression analysis revealed that poor overall survival was independently associated with receiving vasopressors (adjusted hazard ratio [aHR]: 3.81, 95% confidence interval [CI]: 1.65-8.81, p = 0.002) and receiving CRRT (aHR: 5.48, 95% CI: 2.29-13.12, p < 0.001). The PaO/FiO ratio was relatively stable through the third day of pleural drainage among survivors but decreased among non-survivors. The vasopressor dose decreased among survivors but remained relatively stable among non-survivors.
Among mechanically ventilated patients who required pleural drainage, use of vasopressors and CRRT was significantly associated with in-hospital mortality. On the third day of pleural drainage, the changes in PaO/FiO and vasopressor dose were associated with in-hospital mortality.
胸腔积液在机械通气患者中很常见。然而，胸腔引流后预后不良的危险因素尚不清楚。本研究旨在确定接受胸腔引流的机械通气患者院内死亡的相关因素。
这项回顾性研究评估了2015年1月至2020年6月期间韩国两家大学附属医院82例在机械通气期间需要胸腔闭式引流管的连续患者。
中位年龄为76岁（四分位间距[IQR]：64 - 84岁），中位序贯器官衰竭评估（SOFA）评分为11分（IQR：7 - 13）。入住重症监护病房最常见的原因是肺炎（n = 44，53.7%），60例患者（77.9%）有渗出性胸腔积液。胸腔引流期间，动脉血氧分压/吸入氧分数值（PaO/FiO）为210（IQR：153 - 253）；45例患者（54.9%）接受血管升压药治疗，31例患者（37.8%）接受连续性肾脏替代治疗（CRRT）。多变量回归分析显示，总体生存率差与接受血管升压药治疗（校正风险比[aHR]：3.81，95%置信区间[CI]：1.65 - 8.81，p = 0.002）和接受CRRT（aHR：5.48，95%CI：2.29 - 13.12，p < 0.001）独立相关。幸存者在胸腔引流的第三天，PaO/FiO比值相对稳定，但非幸存者则下降。幸存者血管升压药剂量下降，但非幸存者相对稳定。
在需要胸腔引流的机械通气患者中，使用血管升压药和CRRT与院内死亡显著相关。在胸腔引流的第三天，PaO/FiO和血管升压药剂量的变化与院内死亡相关。
