Lee D L, Chiang A A
Department of Internal Medicine, Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
J Formos Med Assoc. 1995 Dec;94 Suppl 2:S120-5.
The application of mechanical ventilation can be life-saving in patients with acute respiratory failure, but is frequently ineffective in terminally ill patients. To analyze the outcome and cost of mechanical ventilation for patients with malignancies, we retrospectively reviewed 115 patients with inoperable solid tumors or hematologic malignancies who received mechanical ventilation. Eighty eight of these 115 patients (77%) died while on mechanical ventilation; 18 patients (16%) were weaned from mechanical ventilation but still died during their hospitalization. Six patients (5%) were discharged but survived less than 3 months and only three patients (3%) survived for more than 3 months after discharge. The total time of mechanical ventilation was 772 person-days, which represented 5.5% (772/13974) of the total mechanical ventilator use in our hospital in 1993. The total hospital cost from initiation of mechanical ventilation to discharge or death of these 115 patients was NT $11,238,022 (US $432,200) and daily hospital cost per person during mechanical ventilation was approximately NT $10,845 (US $420). The "daily cost of discharge survival" (defined as total hospitalization cost from the initiation of mechanical ventilation to discharge or death divided by total discharge person-days) for patients with inoperable solid tumors was NT $73,421 (US $2,820)/per person-day. We concluded that mechanical ventilation should not be routinely used in patients with inoperable solid tumors and hematologic malignancies. Physicians should explain the poor outcome to these patients and their families in advance and inquire about their willingness to forego mechanical ventilation.
机械通气的应用对于急性呼吸衰竭患者可能挽救生命，但对于晚期患者往往无效。为分析机械通气用于恶性肿瘤患者的结局及成本，我们回顾性研究了115例接受机械通气的无法手术的实体瘤或血液系统恶性肿瘤患者。这115例患者中有88例（77%）在机械通气期间死亡；18例患者（16%）撤机，但仍在住院期间死亡。6例患者（5%）出院，但存活时间不足3个月，只有3例患者（3%）出院后存活超过3个月。机械通气总时长为772人日，占我院1993年机械通气总使用时长的5.5%（772/13974）。这115例患者从开始机械通气至出院或死亡的总住院费用为新台币11,238,022元（432,200美元），机械通气期间人均每日住院费用约为新台币10,845元（420美元）。无法手术的实体瘤患者的“出院存活日成本”（定义为从开始机械通气至出院或死亡的总住院费用除以总出院人日）为每人每日新台币73,421元（2,820美元）。我们得出结论，机械通气不应常规用于无法手术的实体瘤和血液系统恶性肿瘤患者。医生应提前向这些患者及其家属说明预后不良情况，并询问他们放弃机械通气的意愿。
