Intensive Care Nursing Team, Asan Medical Center, Seoul, Republic of Korea.
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
Heart Lung. 2023 Jan-Feb;57:222-228. doi: 10.1016/j.hrtlng.2022.10.004. Epub 2022 Oct 18.
Although the proportion of patients with chronic respiratory failure requiring home mechanical ventilation (HMV) is increasing, hospital readmissions in these patients are also increasing.
We investigated the factors for early readmission in patients receiving HMV.
We retrospectively analyzed the data of adult patients readmitted to the hospital within a year who first received HMV and were discharged from the Asan Medical Center between March 2014 and February 2019. We compared the clinical characteristics at discharge before readmission between the early (readmission within 30 days) and late readmission groups (readmission between day 31 and 1 year) and investigated the clinical characteristics and outcomes at readmission.
Of the 116 patients identified, 36.2% had been readmitted early. The patients who received invasive HMV had a higher rate of early readmission than those who received non-invasive HMV. Pneumonia was the most common reason of readmission in the two groups. The rate of aspiration was significantly higher in the early readmission group (28.6% vs. 8.1%; P = .003). In multivariate logistic regression analysis, nasogastric tube feeding, sequelae of pneumonia or acute respiratory distress syndrome, and central nervous system disorders as causes for HMV were significantly associated with early readmission.
Feeding methods and causes for HMV were associated with early readmission. Educating caregivers on respiratory care (suction and feeding methods) is important for preventing early readmission.
尽管需要家庭机械通气（HMV）治疗的慢性呼吸衰竭患者比例在增加，但这些患者的医院再入院率也在增加。
我们研究了接受 HMV 的患者早期再入院的相关因素。
我们回顾性分析了 2014 年 3 月至 2019 年 2 月期间首次在我院接受 HMV 治疗并出院的 1 年内再次入院的成年患者的数据。我们比较了再入院前出院时早期（30 天内再入院）和晚期（31 天至 1 年内再入院）再入院组之间的临床特征，并对再入院时的临床特征和结局进行了调查。
在确定的 116 例患者中，36.2%的患者发生了早期再入院。接受有创 HMV 的患者比接受无创 HMV 的患者早期再入院的比例更高。两组患者再入院的最常见原因均为肺炎。早期再入院组的误吸发生率明显更高（28.6% vs. 8.1%；P =.003）。在多变量逻辑回归分析中，鼻胃管喂养、肺炎或急性呼吸窘迫综合征后遗症以及中枢神经系统疾病作为 HMV 的病因与早期再入院显著相关。
喂养方式和 HMV 的病因与早期再入院有关。对护理人员进行呼吸护理（吸痰和喂养方法）教育对于预防早期再入院很重要。
