Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA.
Veterans Affairs Center for Clinical Management Research, HSR&D Center for Innovation, Ann Arbor, MI, USA.
Medicine (Baltimore). 2022 Jul 8;101(27):e29821. doi: 10.1097/MD.0000000000029821.
Patients who develop persistent critical illness remain in the ICU predominately because they develop new late-onset organ failure(s), which may render them at risk of acquiring a new medical device. The epidemiology and short-term outcomes of patients with persistent critical illness who acquire a new medical device are unknown. We retrospectively studied a cohort admitted to the Veterans Affairs (VA) ICUs from 2014 to 2019. Persistent critical illness was defined as an ICU length of stay of at least 14 days. Receipt of new devices was defined as acquisition of a new tracheostomy, feeding tube (including gastrostomy and jejunostomy tubes), implantable cardiac device, or ostomy. Logistic regression models were fit to identify patient factors associated with the acquisition of each new medical device. Among hospitalized survivors, 90-day posthospitalization discharge location and mortality were identified. From 2014 to 2019, there were 13,184 ICU hospitalizations in the VA which developed persistent critical illness. In total, 30.4% of patients (N = 3998/13,184) acquired at least 1 medical device during their persistent critical illness period. Patients with an initial higher severity of illness and prolonged hospital stay preICU admission had higher odds of acquiring each medical device. Among patients who survived their hospitalization, discharge location and mortality did not significantly differ among those who acquired a new medical device as compared to those who did not. Less than one-third of patients with persistent critical illness acquire a new medical device and no significant difference in short-term outcomes was identified. Future work is needed to understand if the acquisition of new medical devices is contributing to the development of persistent critical illness.
患有持续性重症疾病的患者主要仍留在 ICU，是因为他们发生新的迟发性器官衰竭，这可能使他们有获得新的医疗设备的风险。患有持续性重症疾病并获得新医疗设备的患者的流行病学和短期结局尚不清楚。我们回顾性地研究了 2014 年至 2019 年期间入住退伍军人事务部 (VA) ICU 的队列。持续性重症疾病的定义为 ICU 入住时间至少 14 天。新设备的使用定义为获得新的气管造口术、喂养管（包括胃造口术和空肠造口术管）、植入式心脏设备或造口术。使用逻辑回归模型来确定与获得每种新医疗设备相关的患者因素。在住院幸存者中，确定了 90 天的出院地点和死亡率。2014 年至 2019 年，VA 有 13184 例 ICU 住院患者发生持续性重症疾病。在总共 13184 例患者中，有 30.4%（N=3998/13184）在持续性重症疾病期间至少获得了 1 种医疗设备。初始疾病严重程度较高和 ICU 入院前住院时间较长的患者获得每种医疗设备的可能性更高。在幸存住院的患者中，与未获得新医疗设备的患者相比，获得新医疗设备的患者的出院地点和死亡率没有显著差异。不到三分之一的持续性重症疾病患者获得新的医疗设备，并且未发现短期结局有显著差异。需要进一步研究以了解获得新的医疗设备是否会导致持续性重症疾病的发生。
