Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI.
Chest. 2023 Jan;163(1):128-138. doi: 10.1016/j.chest.2022.08.2210. Epub 2022 Aug 22.
National data on bronchoscopy for the evaluation of acute respiratory failure are lacking, and the limited available data suggest wide variation in use.
How commonly is bronchoscopy performed among hospitalizations with acute respiratory failure? How has use changed over time and across hospitals?
This was an observational cohort study of adult hospitalizations (2012-2018) treated with invasive mechanical ventilation (IMV) using the National Inpatient Sample, which represents 97% of all hospitalizations in the United States. We measured the proportion of hospitalizations treated with IMV who underwent bronchoscopy and assessed trends in bronchoscopy use over time. Multilevel linear regression models were used to quantify hospital-level variation, adjusting for differences in patient and hospital characteristics.
We identified 6,101,070 IMV-treated hospitalizations (2012-2018), of whom 609,405 underwent bronchoscopy; among hospitalizations receiving bronchoscopy, mean age was 61 years, 41.8% were women, and in-hospital mortality was 30.8%. The percentage of IMV-treated hospitalizations receiving bronchoscopy increased from 9.5% (95% CI, 9.1%-9.9%) in 2012 to 10.8% (95% CI, 10.4%-11.2%) in 2018 (P < .001 for difference). In 2018, bronchoscopy use varied from 0% to 57.1% among 1,787 hospitals, and in multilevel models adjusted for patient and hospital characteristics, 16.0% of the variation was explained at the hospital level. The median OR was 2.13 (95% CI, 2.05-2.21), indicating 113% increased odds of receiving bronchoscopy if moving from a lower-use to a higher-use hospital.
Bronchoscopy use among hospitalizations treated with IMV has increased over time. The large variation in use of bronchoscopy across hospitals suggests potentially unwarranted practice variation and need for further studies to clarify which patients benefit from bronchoscopy.
目前缺乏关于急性呼吸衰竭支气管镜检查的全国性数据，而有限的可用数据表明其使用存在广泛差异。
急性呼吸衰竭住院患者中支气管镜检查的实施频率如何？随着时间的推移和医院的不同，使用情况发生了怎样的变化？
这是一项使用全国住院患者样本（代表美国所有住院患者的 97%）对接受有创机械通气（IMV）治疗的成年住院患者（2012-2018 年）进行的观察性队列研究。我们测量了接受 IMV 治疗的住院患者中接受支气管镜检查的比例，并评估了随着时间的推移支气管镜检查使用情况的变化趋势。使用多水平线性回归模型来量化医院层面的差异，并调整患者和医院特征的差异。
我们确定了 6101070 例接受 IMV 治疗的住院患者（2012-2018 年），其中 609405 例接受了支气管镜检查；在接受支气管镜检查的住院患者中，平均年龄为 61 岁，41.8%为女性，院内死亡率为 30.8%。接受 IMV 治疗的住院患者中接受支气管镜检查的比例从 2012 年的 9.5%（95%CI，9.1%-9.9%）增加到 2018 年的 10.8%（95%CI，10.4%-11.2%）（差异 P<.001）。2018 年，1787 家医院的支气管镜使用率从 0%到 57.1%不等，在调整了患者和医院特征的多水平模型中，有 16.0%的变异可以在医院层面上解释。中位数比值比（OR）为 2.13（95%CI，2.05-2.21），这表明如果从低使用率医院转移到高使用率医院，接受支气管镜检查的几率增加了 113%。
接受有创机械通气治疗的住院患者中支气管镜检查的使用频率随着时间的推移而增加。医院间支气管镜检查使用率的巨大差异表明存在潜在的不必要的实践差异，需要进一步研究以明确哪些患者受益于支气管镜检查。
