A Contemporary Assessment of Acute Mechanical Ventilation in Beijing: Description, Costs, and Outcomes
Yanping Ye, Bo Zhu, Li Jiang, et al
Crit Care Med. 2017 Apr 18.
doi: 10.1097/CCM.0000000000002360. [Epub ahead of print]
OBJECTIVE: 目的
To evaluate the contemporary practice, outcomes, and costs related to mechanical ventilation among ICUs in China.
评价当下中国北京地区ICU中机械通气治疗的实施、患者的转归及花费情况。
DESIGN: 设计
A prospective observational cohort study.
前瞻性队列研究。
SETTING: 场景
Fourteen ICUs among 13 hospitals in Beijing, China.
中国北京13家医院的14个ICU。
PATIENTS: 研究人群
Seven hundred ninety-three patients who received at least 24 hours of mechanical ventilation within the first 48 hours of ICU stay.
入住ICU的前48小时内接受了有创机械通气治疗大于24小时的793例患者。
INTERVENTION: 干预措施
None.
无
MEASUREMENTS AND RESULTS: 预后指标与结果
The mean age was 64 years. Sixty-three percent were male. New acute respiratory failure accounted for 85.5% of mechanical ventilation cases. Only 4.7% of the patients received mechanical ventilation for acute exacerbation of chronic obstructive pulmonary disease. The most widely used ventilation mode was the combination of synchronized intermittent mandatory ventilation and pressure support (43.6%). Use of lung-protective ventilation is widespread with tidal volumes of 7.1 mL/kg (2.1 mL/kg). The ICU/hospital mortality was 27.6%/29.3%, respectively (8.5%/9.7% for surgical patients and 41.3%/43.2% for medical patients, respectively). The mean level of ICU/hospital cost per patient was $15,271 (18,940)/$22,946 (25,575), respectively. The mean daily ICU cost per patient was $1,212.
本组患者的平均年龄为64（18）岁，男性患者占63%。急性呼吸衰竭患者占接受机械通气治疗患者的85.5%，慢性阻塞性肺疾病急性加重患者仅占4.7%。最常用机械通气治疗模式为SIMV+PSV（43.6%），机械通气治疗的平均潮气量水平为7.1（2.1）ml/kg。本组患者总体ICU/医院的死亡率为27.6%/29.3%，其中外科患者及内科患者的ICU/医院死亡率分别为8.5%/9.7%及41.3%/43.2%。人均ICU/医院花费为$15,271（18,940）/22,946（25,575），患者日均ICU费用为$1,212。
CONCLUSION: 结论
For the first time, we obtained a preliminary epidemiology data of mechanical ventilation in Beijing, China, through the study. Compared with the other nations, our patients are older, predominantly male, and treated according to prevailing international guidelines yet at a relatively high cost and high mortality. The expanding elderly population predicts increase demand for mechanical ventilation that must be met by continuous improvement in quality and efficiency of critical care services.
本研究首次初步获得了基于中国北京地区的ICU中有关机械通气治疗的流行病学资料。与其他国家的研究结果进行比较，我们的患者更加高龄，更多的男性患者，机械通气治疗的参数设置与目前国际指南指导的相一致，但是存在相对较高的死亡率及相对较高的医疗花费。随着人口的老龄化，机械通气治疗的需求会越来越多，我们需要持续改进危重症医疗服务的有效性，进一步提高危重症医疗服务的质量。
