Robert E. Freundlich is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Gen Li is a senior statistical analyst, Department of Anesthesiology, Vanderbilt University Medical Center.
Am J Crit Care. 2023 Sep 1;32(5):358-367. doi: 10.4037/ajcc2023299.
Patients with sepsis are at risk for mechanical ventilation. This study aimed to identify risk factors for initiation of mechanical ventilation in patients with sepsis and assess whether these factors varied with time.
Data from the electronic health record were used to model risk factors for initiation of mechanical ventilation after the onset of sepsis. A time-varying Cox model was used to study factors that varied with time.
Of 35 020 patients who met sepsis criteria, 28 747 were eligible for inclusion. Mechanical ventilation was initiated within 30 days after sepsis onset in 3891 patients (13.5%). Factors that were independently associated with increased likelihood of receipt of mechanical ventilation were race (White: adjusted hazard ratio [HR], 1.59; 95% CI, 1.39-1.83; other/unknown: adjusted HR, 1.97; 95% CI, 1.54-2.52), systemic inflammatory response syndrome (adjusted HR [per point], 1.23; 95% CI, 1.17-1.28), Sequential Organ Failure Assessment score (adjusted HR [per point], 1.28; 95% CI, 1.26-1.31), and congestive heart failure (adjusted HR, 1.30; 95% CI, 1.17-1.45). Hazard ratios decreased with time for Sequential Organ Failure Assessment score and congestive heart failure and varied with time for 4 comorbidities and 3 culture results.
The risk for mechanical ventilation associated with different factors varied with time after sepsis onset, increasing for some factors and decreasing for others. Through a better understanding of risk factors for initiation of mechanical ventilation in patients with sepsis, targeted interventions may be tailored to high-risk patients.
脓毒症患者有接受机械通气的风险。本研究旨在确定脓毒症患者机械通气启动的危险因素，并评估这些因素是否随时间变化。
使用电子病历数据对脓毒症发作后机械通气启动的危险因素进行建模。采用时变 Cox 模型研究随时间变化的因素。
在符合脓毒症标准的 35020 名患者中，有 28747 名符合纳入标准。30 天内，有 3891 名（13.5%）患者在脓毒症发作后开始机械通气。与机械通气接受率增加独立相关的因素包括种族（白人：调整后的危险比 [HR]，1.59；95%置信区间 [CI]，1.39-1.83；其他/未知：调整后的 HR，1.97；95%CI，1.54-2.52）、全身炎症反应综合征（每增加 1 分的调整 HR [per point]，1.23；95%CI，1.17-1.28）、序贯器官衰竭评估评分（每增加 1 分的调整 HR [per point]，1.28；95%CI，1.26-1.31）和充血性心力衰竭（调整 HR，1.30；95%CI，1.17-1.45）。序贯器官衰竭评估评分和充血性心力衰竭的危险比随时间降低，4 种合并症和 3 种培养结果的危险比随时间变化。
不同因素与机械通气相关的风险随脓毒症发作后时间而变化，对某些因素而言风险增加，对其他因素而言风险降低。通过更好地了解脓毒症患者机械通气启动的危险因素，可以针对高危患者制定有针对性的干预措施。
