Tuberculosis and Respiratory Diseases

  • 제83권4호
  • /
  • Pages.303-311
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  • 2020
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  • 1738-3536(pISSN)
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  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
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The Impact of Mechanical Ventilation Duration on the Readmission to Intensive Care Unit: A Population-Based Observational Study

  • Lee, Hyun Woo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Cho, Young-Jae (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • 투고 : 2020.03.14
  • 심사 : 2020.08.20
  • 발행 : 2020.10.31
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초록

Background: If the duration of mechanical ventilation (MV) is related with the intensive care unit (ICU) readmission must be clarified. The purpose of this study was to elucidate if prolonged MV duration increases ICU readmission rate. Methods: The present observational cohort study analyzed national healthcare claims data from 2006 to 2015. Critically ill patients who received MV in the ICU were classified into five groups according to the MV duration: MV for <7 days, 7-13 days, 14-20 days, 21-27 days, and ≥28 days. The rate and risk of the ICU readmission were estimated according to the MV duration using the unadjusted and adjusted analyses. Results: We found that 12,929 patients had at least one episode of MV in the ICU. There was a significant linear relationship between the MV duration and the ICU readmission (R2=0.85, p=0.025). The total readmission rate was significantly higher as the MV duration is prolonged (MV for <7 days, 13.9%; for 7-13 days, 16.7%; for 14-20 days, 19.4%; for 21-27 days, 20.4%; for ≥28 days, 35.7%; p<0.001). The analyses adjusted by covariables and weighted with the multinomial propensity scores showed similar results. In the adjusted regression analysis with a Cox proportional hazards model, the MV duration was significantly related to the ICU readmission (hazard ratio, 1.058 [95% confidence interval, 1.047-1.069], p<0.001). Conclusion: The rate of readmission to the ICU was significantly higher in patients who received longer durations of the MV in the ICU. In the clinical setting, closer observation of patients discharged from the ICU after prolonged periods of MV is required.

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참고문헌

  1. Metnitz PG, Fieux F, Jordan B, Lang T, Moreno R, Le Gall JR. Critically ill patients readmitted to intensive care units: lessons to learn? Intensive Care Med 2003;29:241-8. https://doi.org/10.1007/s00134-002-1584-z
  2. Renton J, Pilcher DV, Santamaria JD, Stow P, Bailey M, Hart G, et al. Factors associated with increased risk of readmission to intensive care in Australia. Intensive Care Med 2011;37:1800-8. https://doi.org/10.1007/s00134-011-2318-x
  3. Rosenberg AL, Hofer TP, Hayward RA, Strachan C, Watts CM. Who bounces back? Physiologic and other predictors of intensive care unit readmission. Crit Care Med 2001;29:511-8. https://doi.org/10.1097/00003246-200103000-00008
  4. Rosenberg AL, Watts C. Patients readmitted to ICUs: a systematic review of risk factors and outcomes. Chest 2000;118:492-502. https://doi.org/10.1378/chest.118.2.492
  5. Gajic O, Malinchoc M, Comfere TB, Harris MR, Achouiti A, Yilmaz M, et al. The Stability and Workload Index for Transfer score predicts unplanned intensive care unit patient readmission: initial development and validation. Crit Care Med 2008;36:676-82. https://doi.org/10.1097/CCM.0B013E318164E3B0
  6. Ouanes I, Schwebel C, Francais A, Bruel C, Philippart F, Vesin A, et al. A model to predict short-term death or readmission after intensive care unit discharge. J Crit Care 2012;27:422.
  7. Ponzoni CR, Correa TD, Filho RR, Serpa Neto A, Assuncao MS, Pardini A, et al. Readmission to the intensive care unit: incidence, risk factors, resource use, and outcomes: a retrospective cohort study. Ann Am Thorac Soc 2017;14:1312-9. https://doi.org/10.1513/AnnalsATS.201611-851OC
  8. Campbell AJ, Cook JA, Adey G, Cuthbertson BH. Predicting death and readmission after intensive care discharge. Br J Anaesth 2008;100:656-62. https://doi.org/10.1093/bja/aen069
  9. Hill AD, Fowler RA, Burns KE, Rose L, Pinto RL, Scales DC. Long-term outcomes and health care utilization after prolonged mechanical ventilation. Ann Am Thorac Soc 2017;14:355-62. https://doi.org/10.1513/AnnalsATS.201610-792OC
  10. Damuth E, Mitchell JA, Bartock JL, Roberts BW, Trzeciak S. Long-term survival of critically ill patients treated with prolonged mechanical ventilation: a systematic review and metaanalysis. Lancet Respir Med 2015;3:544-53. https://doi.org/10.1016/S2213-2600(15)00150-2
  11. Oeyen SG, Vandijck DM, Benoit DD, Annemans L, Decruyenaere JM. Quality of life after intensive care: a systematic review of the literature. Crit Care Med 2010;38:2386-400. https://doi.org/10.1097/CCM.0b013e3181f3dec5
  12. Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000;342:1471-7. https://doi.org/10.1056/NEJM200005183422002
  13. Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, et al. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 1999;27:2609-15. https://doi.org/10.1097/00003246-199912000-00001
  14. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007;370:1453-7. https://doi.org/10.1016/S0140-6736(07)61602-X
  15. Lee J, Lee JS, Park SH, Shin SA, Kim K. Cohort Profile: The National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Int J Epidemiol 2017;46:e15. https://doi.org/10.1093/ije/dyv319
  16. Lee HW, Ji E, Ahn S, Yang HJ, Yoon SY, Park TY, et al. A population-based observational study of patients with pulmonary disorders in intensive care unit. Korean J Intern Med 2019 Nov 25 [Epub]. https://doi.org/10.3904/kjlm.2018.449.
  17. Burgette L, Griffin BA, McCaffrey D; RAND Corporation. Propensity scores for multiple treatments: a tutorial for the mnps function in the twang package. Santa Monica: RAND Corporation; 2017.
  18. Brown SE, Ratcliffe SJ, Kahn JM, Halpern SD. The epidemiology of intensive care unit readmissions in the United States. Am J Respir Crit Care Med 2012;185:955-64. https://doi.org/10.1164/rccm.201109-1720OC
  19. Lone NI, Walsh TS. Prolonged mechanical ventilation in critically ill patients: epidemiology, outcomes and modelling the potential cost consequences of establishing a regional weaning unit. Crit Care 2011;15:R102. https://doi.org/10.1186/cc10117
  20. Arabi Y, Venkatesh S, Haddad S, Al Shimemeri A, Al Malik S. A prospective study of prolonged stay in the intensive care unit: predictors and impact on resource utilization. Int J Qual Health Care 2002;14:403-10. https://doi.org/10.1093/intqhc/14.5.403
  21. Moitra VK, Guerra C, Linde-Zwirble WT, Wunsch H. Relationship between ICU length of stay and long-term mortality for elderly ICU survivors. Crit Care Med 2016;44:655-62. https://doi.org/10.1097/ccm.0000000000001480
  22. Jubran A, Tobin MJ. Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med 1997;155:906-15. https://doi.org/10.1164/ajrccm.155.3.9117025
  23. Appendini L, Purro A, Patessio A, Zanaboni S, Carone M, Spada E, et al. Partitioning of inspiratory muscle workload and pressure assistance in ventilator-dependent COPD patients. Am J Respir Crit Care Med 1996;154:1301-9. https://doi.org/10.1164/ajrccm.154.5.8912740
  24. Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, et al. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit Care Med 2018;197:204-13. https://doi.org/10.1164/rccm.201703-0536oc
  25. Schweickert WD, Hall J. ICU-acquired weakness. Chest 2007;131:1541-9. https://doi.org/10.1378/chest.06-2065
  26. Griffiths RD, Hall JB. Intensive care unit-acquired weakness. Crit Care Med 2010;38:779-87. https://doi.org/10.1097/CCM.0b013e3181cc4b53
  27. Turon M, Fernandez-Gonzalo S, de Haro C, Magrans R, Lopez-Aguilar J, Blanch L. Mechanisms involved in brain dysfunction in mechanically ventilated critically ill patients: implications and therapeutics. Ann Transl Med 2018;6:30. https://doi.org/10.21037/atm.2017.12.10
  28. Lin SM, Huang CD, Liu CY, Lin HC, Wang CH, Huang PY, et al. Risk factors for the development of early-onset delirium and the subsequent clinical outcome in mechanically ventilated patients. J Crit Care 2008;23:372-9. https://doi.org/10.1016/j.jcrc.2006.09.001
  29. Scheinhorn DJ, Hassenpflug MS, Votto JJ, Chao DC, Epstein SK, Doig GS, et al. Post-ICU mechanical ventilation at 23 longterm care hospitals: a multicenter outcomes study. Chest 2007;131:85-93. https://doi.org/10.1378/chest.06-1081
  30. O'Connor HH, Kirby KJ, Terrin N, Hill NS, White AC. Decannulation following tracheostomy for prolonged mechanical ventilation. J Intensive Care Med 2009;24:187-94. https://doi.org/10.1177/0885066609332701
  31. Jubran A, Lawm G, Kelly J, Duffner LA, Gungor G, Collins EG, et al. Depressive disorders during weaning from prolonged mechanical ventilation. Intensive Care Med 2010;36:828-35. https://doi.org/10.1007/s00134-010-1842-4
  32. Seneff MG, Zimmerman JE, Knaus WA, Wagner DP, Draper EA. Predicting the duration of mechanical ventilation. The importance of disease and patient characteristics. Chest 1996;110:469-79. https://doi.org/10.1378/chest.110.2.469
  33. Gadre SK, Duggal A, Mireles-Cabodevila E, Krishnan S, Wang XF, Zell K, et al. Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD). Medicine (Baltimore) 2018;97:e0487. https://doi.org/10.1097/MD.0000000000010487
  34. Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 2002;287:345-55. https://doi.org/10.1001/jama.287.3.345
  35. Figueroa-Casas JB, Connery SM, Montoya R, Dwivedi AK, Lee S. Accuracy of early prediction of duration of mechanical ventilation by intensivists. Ann Am Thorac Soc 2014;11:182-5. https://doi.org/10.1513/annalsats.201307-222oc
  36. Hira HS, Mittal A. Evaluation of the predictors for duration of mechanical ventilation in respiratory intensive care unit. Lung India 2006;23:70-4. https://doi.org/10.4103/0970-2113.44412