Abstract：
BACKGROUND: Severe respiratory failure requires numerous interventions and its clinical implementation changes over time. We aimed to clarify the clinical practice and prognosis of severe respiratory failure and its changes over time.
METHODS: In a nationwide Japanese administrative database from 2016 to 2019, we identified nonoperative patients with severe respiratory failure without congestive heart failure as the main diagnosis who received mechanical ventilation (MV) for more than four days. We examined trends in patient characteristics, adjunctive interventions, and prognosis.
RESULTS: Among 66,905 patients included in this study, patients received antibiotics (90%), high-dose corticosteroids (14%), low-dose corticosteroids (18%), and 51% were admitted to the critical care unit. Hospital mortality was 35%. Median mechanical ventilation lasted 10 days. Tracheostomy occurred in 23% of cases. Median critical care and hospital stays were 10 and 25 days, respectively. Among survivors, 23% had mechanical ventilation dependency at hospital discharge. Large relative changes in adjunctive therapies included fentanyl (30%-38%), rocuronium (4.4%-6.7%), vasopressin (3.8%-6.0%), early rehabilitation (27%-38%), extracorporeal membrane oxygenation (0.7%-1.2%), dopamine (15%-10%), and sivelestat (8.6%-3.5%). No notable changes were seen in mechanical ventilation duration, tracheostomy, critical care unit stay, hospital stay, or ventilator dependency at discharge, except for a slight reduction in hospital mortality (36%-34%).
CONCLUSIONS: Several adjunctive therapies for severe respiratory failure changed from 2016 to 2019, with an increase in evidence-based practices and a slight decrease in hospital mortality.
METHODS: In a nationwide Japanese administrative database from 2016 to 2019, we identified nonoperative patients with severe respiratory failure without congestive heart failure as the main diagnosis who received mechanical ventilation (MV) for more than four days. We examined trends in patient characteristics, adjunctive interventions, and prognosis.
RESULTS: Among 66,905 patients included in this study, patients received antibiotics (90%), high-dose corticosteroids (14%), low-dose corticosteroids (18%), and 51% were admitted to the critical care unit. Hospital mortality was 35%. Median mechanical ventilation lasted 10 days. Tracheostomy occurred in 23% of cases. Median critical care and hospital stays were 10 and 25 days, respectively. Among survivors, 23% had mechanical ventilation dependency at hospital discharge. Large relative changes in adjunctive therapies included fentanyl (30%-38%), rocuronium (4.4%-6.7%), vasopressin (3.8%-6.0%), early rehabilitation (27%-38%), extracorporeal membrane oxygenation (0.7%-1.2%), dopamine (15%-10%), and sivelestat (8.6%-3.5%). No notable changes were seen in mechanical ventilation duration, tracheostomy, critical care unit stay, hospital stay, or ventilator dependency at discharge, except for a slight reduction in hospital mortality (36%-34%).
CONCLUSIONS: Several adjunctive therapies for severe respiratory failure changed from 2016 to 2019, with an increase in evidence-based practices and a slight decrease in hospital mortality.
摘要：
背景：严重呼吸衰竭需要多种干预措施，其临床实施会随着时间的推移而变化。我们旨在阐明严重呼吸衰竭的临床实践和预后及其随时间的变化。
方法：在2016年至2019年的日本全国行政数据库中，我们将接受机械通气（MV）超过4天的严重呼吸衰竭且无充血性心力衰竭的非手术患者确定为主要诊断。我们检查了患者特征的趋势，辅助干预措施，和预后。
结果：在纳入本研究的66,905名患者中，患者接受抗生素治疗（90%），大剂量皮质类固醇（14%），低剂量皮质类固醇（18％），51%被送进重症监护病房.医院死亡率为35%。中位机械通气持续10天。23％的病例发生气管切开术。重症监护和住院时间中位数分别为10天和25天，分别。在幸存者中，23％的人在出院时有机械通气依赖性。辅助治疗的较大相对变化包括芬太尼（30％-38％），罗库溴铵（4.4%-6.7%），加压素（3.8%-6.0%），早期康复(27%-38%)，体外膜氧合（0.7%-1.2%），多巴胺（15%-10%），和西维莱斯特（8.6%-3.5%）。机械通气时间未见明显变化，气管造口术,重症监护病房住院,住院,或出院时依赖呼吸机，除了医院死亡率略有下降（36％-34％）。
结论：从2016年到2019年，严重呼吸衰竭的几种辅助疗法发生了变化，循证实践有所增加，医院死亡率略有下降。
方法：在2016年至2019年的日本全国行政数据库中，我们将接受机械通气（MV）超过4天的严重呼吸衰竭且无充血性心力衰竭的非手术患者确定为主要诊断。我们检查了患者特征的趋势，辅助干预措施，和预后。
结果：在纳入本研究的66,905名患者中，患者接受抗生素治疗（90%），大剂量皮质类固醇（14%），低剂量皮质类固醇（18％），51%被送进重症监护病房.医院死亡率为35%。中位机械通气持续10天。23％的病例发生气管切开术。重症监护和住院时间中位数分别为10天和25天，分别。在幸存者中，23％的人在出院时有机械通气依赖性。辅助治疗的较大相对变化包括芬太尼（30％-38％），罗库溴铵（4.4%-6.7%），加压素（3.8%-6.0%），早期康复(27%-38%)，体外膜氧合（0.7%-1.2%），多巴胺（15%-10%），和西维莱斯特（8.6%-3.5%）。机械通气时间未见明显变化，气管造口术,重症监护病房住院,住院,或出院时依赖呼吸机，除了医院死亡率略有下降（36％-34％）。
结论：从2016年到2019年，严重呼吸衰竭的几种辅助疗法发生了变化，循证实践有所增加，医院死亡率略有下降。
