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Resultados a tres años para los beneficiarios de Medicare que sobreviven a la terapia intensiva
Hannah Wunsch1, Carmen Guerra, Amber E Barnato
1Department of Anesthesiology, Columbia University, 622 W 168th St, PH-527D, New York, NY 10032, USA. hw2125@columbia.edu
JAMA
|March 4, 2010
Resumen
Los pacientes ancianos que sobreviven a cuidados intensivos tienen una mayor mortalidad a los 3 años que los controles generales o hospitalizados. La ventilación mecánica aumenta significativamente este riesgo, especialmente en los primeros seis meses después de la descarga.
Área de la Ciencia:
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Medicina Geriátrica La medicina geriátrica es una especialidad de la medicina geriátrica.
- Salud Pública La salud pública.
Sus antecedentes:
- La mortalidad hospitalaria para pacientes de la unidad de cuidados intensivos (UCI) ha disminuido.
- Los resultados a largo plazo para los sobrevivientes de la UCI no se comprenden bien.
Objetivo del estudio:
- Evaluar las tasas de supervivencia a 3 años y los resultados para los beneficiarios de Medicare que sobreviven a la terapia intensiva.
Principales métodos:
- Estudio de cohorte retrospectivo de beneficiarios de Medicare mayores de 65 años.
- Los controles emparejados incluyeron pacientes hospitalizados y la población general.
- Seguimiento durante 3 años después del alta hospitalaria.
Principales resultados:
- Los sobrevivientes de la UCI tuvieron una mayor mortalidad a los 3 años (39,5%) en comparación con los controles hospitalarios (34,5%) y generales (14,9%).
- La ventilación mecánica aumentó significativamente el riesgo de mortalidad (57,6% frente a 32,8% para los controles).
- El alta a un centro de atención especializada se asoció con una mayor mortalidad a los 6 meses.
Conclusiones:
- Un número sustancial de personas mayores que sobreviven a cuidados intensivos enfrentan una elevada mortalidad a largo plazo.
- La ventilación mecánica es un factor clave que impulsa el aumento de la mortalidad posterior a la UCI.
- El período posterior a la baja temprana es crítico para los sobrevivientes de UCI de alto riesgo.
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