Kao Li-Ting, Yang Chun-Chieh, Wu Yu-Cih, Ko Shian-Chin, Liang Yi-Shan, Liao Kuang-Ming, Ho Chung-Han
Department of Respiratory Therapy, Chi-Mei Medical Center, Tainan, Taiwan.
Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
J Multidiscip Healthc. 2025 Mar 20;18:1695-1709. doi: 10.2147/JMDH.S509022. eCollection 2025.
Palliative care is underutilized for severely ill patients with advanced chronic obstructive pulmonary disease (COPD) experiencing significant symptoms during hospitalization. The impact of mechanical ventilation on inpatient palliative care utilization remains largely unexplored. In this study, we aimed to investigate inpatient palliative care utilization among hospitalized patients with COPD requiring mechanical ventilation and examine the associated risk factors and clinical outcomes.
A retrospective nested case-control study was conducted using population-based claims datasets from 2017 to 2021. It included 36,848 hospitalized patients with COPD aged 40 and above, of which 16,118 (43.74%) required mechanical ventilation. Logistic regression was used to assess the association between mechanical ventilation and inpatient palliative care utilization, adjusting for relevant covariates.
Of the total cohort, 5,596 patients (15.19%) utilized inpatient palliative care, including 1,275 (7.91%) requiring mechanical ventilation. Age, duration of mechanical ventilation, comorbidity severity, and hospital type influenced inpatient palliative care use. Patients with a Charlson Comorbidity Index score of 1-2 and ≥3 were 24.06 and 51.59 times more likely, respectively, to receive palliative care compared to those with a Charlson Comorbidity Index score of 0. Ventilated patients in medical centers or regional hospitals were more likely to receive palliative care than those in district hospitals. Patients on mechanical ventilation who received care for 8-30 days were over twice as likely to receive palliative care compared to those who received care for shorter durations.
Inpatient palliative care for patients with COPD was limited and varied based on the duration of mechanical ventilation and hospital type. To enhance patient-centered care, interdisciplinary teams should integrate palliative care throughout the illness journey.
姑息治疗在住院期间出现明显症状的晚期慢性阻塞性肺疾病（COPD）重症患者中未得到充分利用。机械通气对住院姑息治疗利用的影响在很大程度上仍未得到探索。在本研究中，我们旨在调查需要机械通气的住院COPD患者的住院姑息治疗利用情况，并检查相关危险因素和临床结局。
使用2017年至2021年基于人群的索赔数据集进行了一项回顾性巢式病例对照研究。研究纳入了36848名年龄在40岁及以上的住院COPD患者，其中16118名（43.74%）需要机械通气。采用逻辑回归评估机械通气与住院姑息治疗利用之间的关联，并对相关协变量进行调整。
在整个队列中，5596名患者（15.19%）使用了住院姑息治疗，其中1275名（7.91%）需要机械通气。年龄、机械通气持续时间、合并症严重程度和医院类型影响住院姑息治疗的使用。Charlson合并症指数评分为1 - 2分和≥3分的患者接受姑息治疗的可能性分别是Charlson合并症指数评分为0分患者的24.06倍和51.59倍。与地区医院的患者相比，医疗中心或区域医院接受机械通气的患者更有可能接受姑息治疗。接受机械通气8 - 30天的患者接受姑息治疗的可能性是接受治疗时间较短患者的两倍多。
COPD患者的住院姑息治疗有限，且因机械通气持续时间和医院类型而异。为了加强以患者为中心的护理，跨学科团队应在整个疾病过程中整合姑息治疗。
