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학제간연구 과학기술학 뇌인지과학 기술정책 기타 복합학

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논문 기본 정보

자료유형
학술저널
저자정보
이정모 (국민건강보험공단 일산병원) 이선민 (국민건강보험공단 일산병원) 송주한 (세브란스병원) 김영삼 (연세대학교)
저널정보
대한중환자의학회 Acute and Critical Care Acute and Critical Care 제35권 제3호
발행연도
2020.1
수록면
156 - 163 (8page)

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Background: Ventilator-dependent patients in the intensive care unit (ICU) who are difficult to wean from invasive mechanical ventilation (IMV) have been increasing in number. However, data on the clinical outcomes of difficult-to-wean patients are lacking. We aimed to evaluate clinical outcomes in patients discharged from the ICU with tracheostomy and ventilator dependency. Methods: We retrospectively investigated clinical course and survival in patients requiring home mechanical ventilation (HMV) with a tracheostomy and difficulty weaning from IMV during medical ICU admission from September 2013 through August 2016 at Severance Hospital, Yonsei University, Seoul, Korea. Results: Of 84 difficult-to-wean patients who were started on HMV in the medical ICU, 72 survived, were discharged from the ICU, and were included in this analysis. HMV was initiated after a median of 23 days of IMV, and the successful weaning rate was 46% (n=33). In-hospital mortality rate was significantly lower in the successfully weaned group than the unsuccessfully weaned group (0% vs. 23.1%, respectively; P=0.010). Weaning rates were similar according to primary diagnosis, but high body mass index (BMI), low Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score at ICU admission, and absence of neuromuscular disease were associated with weaning success. After a median follow-up of 4.6 months (range, 1?27 months) for survivors, 3-month (n=64) and 6-month (n=59) survival rates were 82.5% and 72.2%, respectively. Survival rates were higher in the successfully weaned group than the unsuccessfully weaned group at 3 months (96.4% vs. 69.0%; P=0.017) and 6 months (84.0% vs. 62.1%; P=0.136) following ICU discharge. Conclusions: In summary, 46% of patients who started HMV were successfully weaned from the ventilator in general wards. High BMI, low APACHE II score, and absence of neuromuscular disease were factors associated with weaning success.
#intensive care unit #mechanical ventilators #ventilator weaning

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참고문헌 (25)

참고문헌 신청
Ambrosino N / 2010 / The difficult-to-wean patient / Expert Rev Respir Med 4:685~692 google schola Esteban A / 2000 / How is mechanical ventilation employed in the intensive care unit? An international utilization review / Am J Respir Crit Care Med 161:1450~1458 google schola Boles JM / 2007 / Weaning from mechanical ventilation / Eur Respir J 29:1033~1056 google schola MacIntyre NR / 2001 / Evidence-based guidelines for weaning and discontinuing ventilatory support : a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine / Chest 120(6 Suppl):375S~395S google schola Kahn JM / 2009 / Development and validation of an algorithm for identifying prolonged mechanical ventilation in administrative data / Health Serv Outcomes Res Methodol 9:117~132 google schola

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