目的:确定与住院死亡率相关的因素,评估急诊(ED)中65岁以上接受有创机械通气(IMV)的患者的插管率并描述院内死亡率。
方法:65岁以上患者的回顾性队列研究,他们在2016年至2018年期间在一家高复杂性医院的ED中插管。人口统计数据,合并症,并描述了入院时的严重程度评分。根据死亡率和可能的混杂因素,采用逻辑回归进行双变量和多变量分析。
结果:共有285名平均年龄80岁的患者在急诊科需要IMV,中位数为3天,平均APACHEII评分为20分。IMV率为.48%(95%CI.43-.54),55.44%(158人)死亡。年龄和性别调整后的死亡率相关因素是卒中(OR2.13;95%CI1.21-3.76),慢性肾衰竭,(或4。,38;95%CI1.91-10.04),查尔逊指数(OR1.19;95%CI1.02-1.38),APACHEII评分(OR1.07;95%CI1.02-1.12),和SOFA评分(OR1.14;95%CI1.03-1.27)。
结论:我们的IMV率低于Johnson等人的报告。2018年在美国(.59%)。我们研究中的住院死亡率超过了APACHEII评分(40%)和SOFA(33%)预测的死亡率。然而,这与Lieberman等人报道的一致。在以色列和埃斯特万等人。在美国。
结论:尽管ED的IMV率很低,超过一半的病人在住院期间死亡。预先存在的脑血管和肾脏疾病以及入院时合并症指数和严重程度评分的高结果是与住院死亡率相关的独立因素。
OBJECTIVE: To identify factors associated with in-hospital mortality, to estimate the intubation rate and to describe in-hospital mortality in patients over 65 years old with invasive mechanical ventilation (IMV) in the emergency department (ED).
METHODS: Retrospective cohort study of patients over 65 years old, who were intubated in an ED of a high complexity hospital between 2016 and 2018. Demographic data, comorbidities, and severity scores on admission were described. Bivariate and multivariate analyses were performed with logistic regression according to mortality and possible confounders.
RESULTS: A total of 285 patients with a mean age of 80 years required IMV in the emergency department, for a median of 3 days, and with a mean APACHE II score of 20 points of severity. The IMV rate was .48% (95% CI .43-.54), and 55.44% (158) died. Mortality-associated factors after age and sex adjustment were stroke (OR 2.13; 95% CI 1.21-3.76), chronic kidney failure, (OR 4.,38; 95% CI 1.91-10.04), Charlson index (OR 1.19; 95% CI 1.02-1.38), APACHE II score (OR 1.07; 95% CI 1.02-1.12), and SOFA score (OR 1.14; 95% CI 1.03-1.27).
CONCLUSIONS: Our IMV rate was lower than that stated by Johnson et al. in the United States in 2018 (.59%). In-hospital mortality in our study exceeded that predicted by the APACHE II score (40%) and SOFA (33%). However it was consistent with that reported by Lieberman et al. in Israel and Esteban et al. in the United States.
CONCLUSIONS: Although the IMV rate was low in the ED, more than half the patients died during hospitalization. Pre-existing cerebrovascular and renal diseases and high results in the comorbidities index and severity scores on admission were independent factors associated with in-hospital mortality.