重症患者的长期机械通气：六个月死亡率、护理路径及生活质量
Prolonged Mechanical Ventilation in Critically Ill Patients: Six-Month Mortality, Care Pathways, and Quality of Life.
作者信息
Paul Nicolas, Ribet Buse Elena, Grunow Julius J, Schaller Stefan J, Spies Claudia D, Edel Andreas, Weiss Björn
机构信息
Charité-Universtätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany.
Charité-Universtätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany; Medical University of Vienna, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Clinical Division of General Anaesthesia and Intensive Care Medicine, Vienna, Austria.
出版信息
Chest. 2025 Jul;168(1):106-118. doi: 10.1016/j.chest.2025.01.018. Epub 2025 Jan 27.
BACKGROUND
There is limited knowledge about long-term mortality, care pathways, and health-related quality of life (HrQoL) among patients in the ICU receiving prolonged mechanical ventilation (PMV).
RESEARCH QUESTION
What are the long-term mortality, care pathways, and HrQoL of patients receiving invasive PMV, stratified by weaning success?
STUDY DESIGN AND METHODS
We conducted a secondary analysis of patients from the cluster-randomized controlled Enhanced Recovery After Intensive Care trial who were treated in 2 ICU clusters and received invasive PMV (≥ 21 days via endotracheal tube/tracheostomy or ≥ 4 days via tracheostomy). Data on weaning success, mortality, care place transitions, readmissions, and HrQoL were collected for 6 months after ICU discharge.
RESULTS
Of 90 patients receiving PMV in the ICU, 46% (41 of 90 patients) died (21 patients in the ICU and 20 patients within 6 months after ICU discharge). Of 69 patients discharged alive, 25% (17 of 69 patients) could not be weaned, whereas 75% (52 of 69 patients) were successfully weaned within 6 months. Patients experienced a median of 3 (Q1, Q3: 2, 5) care place transitions within 6 months, with more care place transitions among successfully weaned patients (median, 4 [Q1, Q3: 2, 5] vs 2 [1, 3], P = .004). The readmission rate among all patients was 46% within 6 months. One-half of the successfully weaned patients transitioned home, whereas unsuccessfully weaned patients mostly transitioned from weaning centers to nursing homes or died. Unsuccessfully weaned patients had fewer quality-adjusted life days within 6 months than successfully weaned patients (median, 0 [Q1, Q3: 0, 32.6] vs 73.1 [23.2, 135], P = .002).
INTERPRETATION
Our results show that three-quarters of patients receiving PMV who were discharged alive were weaned, but their HrQoL was reduced. The decision to proceed with PMV should weigh in patient preferences for living with HrQoL limitations and patients' likelihood of weaning.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov; No.: NCT03671447; URL: www.
CLINICALTRIALS
gov.
背景
对于重症监护病房（ICU）中接受长时间机械通气（PMV）的患者，关于其长期死亡率、护理途径和健康相关生活质量（HrQoL）的了解有限。
研究问题
接受有创PMV的患者的长期死亡率、护理途径和HrQoL如何，按撤机成功与否分层？
研究设计与方法
我们对来自集群随机对照的重症监护后强化康复试验的患者进行了二次分析，这些患者在2个ICU集群中接受治疗并接受有创PMV（经气管插管/气管切开术≥21天或经气管切开术≥4天）。在ICU出院后6个月收集关于撤机成功、死亡率、护理地点转移、再入院和HrQoL的数据。
结果
在ICU接受PMV的90例患者中，46%（90例患者中的41例）死亡（21例在ICU内死亡，20例在ICU出院后6个月内死亡）。在69例存活出院的患者中，25%（69例患者中的17例）无法撤机，而75%（69例患者中的52例）在6个月内成功撤机。患者在6个月内护理地点转移的中位数为3次（第一四分位数，第三四分位数：2，5），成功撤机的患者护理地点转移更多（中位数，4次[第一四分位数，第三四分位数：2，5]对2次[1，3]，P = 0.004）。所有患者的6个月内再入院率为46%。成功撤机的患者中有一半回家，而撤机失败的患者大多从撤机中心转移到疗养院或死亡。撤机失败的患者在6个月内的质量调整生命天数少于成功撤机的患者（中位数，0天[第一四分位数，第三四分位数：0，32.6]对73.1天[23.2，135]，P = 0.002）。
解读
我们的结果表明，存活出院的接受PMV的患者中有四分之三成功撤机，但他们的HrQoL降低。进行PMV的决定应权衡患者对在HrQoL受限情况下生活的偏好以及患者撤机的可能性。
临床试验注册
ClinicalTrials.gov；编号：NCT03671447；网址：www. ClinicalTrials.gov 。
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