Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Crit Care. 2024 Sep 9;28(1):297. doi: 10.1186/s13054-024-05064-1.
The potential adverse effects associated with invasive mechanical ventilation (MV) can lead to delayed decisions on starting MV. We aimed to explore the association between the timing of MV and the clinical outcomes in patients with sepsis ventilated in intensive care unit (ICU).
We analyzed data of adult patients with sepsis between September 2019 and December 2021. Data was collected through the Korean Sepsis Alliance from 20 hospitals in Korea. Patients who were admitted to ICU and received MV were included in the study. Patients were divided into 'early MV' and 'delayed MV' groups based on whether they were on MV on the first day of ICU admission or later. Propensity score matching was applied, and patients in the two groups were compared on a 1:1 ratio to overcome bias between the groups. Outcomes including ICU mortality, hospital mortality, length of hospital and ICU stay, and organ failure at ICU discharge were compared.
Out of 2440 patients on MV during ICU stay, 2119 'early MV' and 321 'delayed MV' cases were analyzed. The propensity score matching identified 295 patients in each group with similar baseline characteristics. ICU mortality was lower in 'early MV' group than 'delayed MV' group (36.3% vs. 46.4%; odds ratio, 0.66; 95% confidence interval, 0.47-0.93; p = 0.015). 'Early MV' group had lower in-hospital mortality, shorter ICU stay, and required tracheostomy less frequently than 'delayed MV' group. Multivariable logistic regression model identified 'early MV' as associated with lower ICU mortality (odds ratio, 0.38; 95% confidence interval, 0.29-0.50; p < 0.001).
In patients with sepsis ventilated in ICU, earlier start (first day of ICU admission) of MV may be associated with lower mortality.
有创机械通气（MV）可能带来的潜在不良影响会导致对开始 MV 的决策延迟。我们旨在探讨 ICU 中接受 MV 的脓毒症患者 MV 开始时间与临床结局之间的关联。
我们分析了 2019 年 9 月至 2021 年 12 月间脓毒症成年患者的数据。该数据由韩国脓毒症联盟从韩国 20 家医院采集。纳入 ICU 入院时即接受 MV 或之后开始接受 MV 的患者。根据患者是否在 ICU 入院第 1 天即开始 MV 将其分为“早期 MV”和“延迟 MV”组。应用倾向评分匹配，按 1:1 比例将两组患者进行匹配，以克服组间偏倚。比较两组患者的 ICU 死亡率、医院死亡率、住院和 ICU 住院时间以及 ICU 出院时的器官衰竭情况。
在 ICU 期间接受 MV 的 2440 例患者中，分析了 2119 例“早期 MV”和 321 例“延迟 MV”病例。倾向评分匹配后，每组各有 295 例患者，两组患者的基线特征相似。与“延迟 MV”组相比，“早期 MV”组的 ICU 死亡率更低（36.3% vs. 46.4%；比值比，0.66；95%置信区间，0.47-0.93；p=0.015）。“早期 MV”组的住院死亡率更低，ICU 住院时间更短，且需要气管切开术的频率更低。多变量逻辑回归模型显示，“早期 MV”与较低的 ICU 死亡率相关（比值比，0.38；95%置信区间，0.29-0.50；p<0.001）。
在 ICU 中接受 MV 的脓毒症患者中，更早（ICU 入院第 1 天）开始 MV 可能与死亡率降低相关。
