在3个国家使用机械通风
Naheed K Jivraj1,2, Andrea D Hill3, Meng-Shiou Shieh4
1Interdepartmental Division of Critical Care Medicine, University of Toronto, Ontario, Canada.
JAMA internal medicine
|June 26, 2023
概括
侵入性机械通风 (IMV) 的使用在2018年在高收入国家有很大差异,美国的使用率是英格兰的四倍. 这种分歧在老年人中最为明显,突出了了解资源利用的必要性.
科学领域:
- 临界护理医学 临界护理医学
- 医疗保健服务研究 医疗服务研究
- 相对的有效性比较
背景情况:
- 侵入性机械通风 (IMV) 是重症监护室 (ICU) 中的一个关键干预措施.
- 在ICU床位的可用性方面存在显著的国际差异,但各国IMV利用率的数据有限.
研究的目的:
- 为了比较三个高收入国家的成年人均IMV率:英格兰,加拿大和美国.
- 调查这些国家的IMV发病率如何因年龄和特定的并发症而有所不同.
主要方法:
- 一项回顾性队列研究分析了2018年接受IMV的成年患者 (≥20岁) 的数据.
- 包括来自英格兰,加拿大和美国的患者,比较年龄标准化的IMV和ICU入院率.
- 发病率按年龄组和关键诊断/并发症 (例如痴呆症,透析依赖) 分层.
主要成果:
- 美国拥有最高的年龄标准化IMV率 (每10万人口中有614人),其次是加拿大 (290) 和英格兰 (131).
- 随着年龄的增长,IMV的使用差异显著,美国在80岁以上的成年人中,与加拿大和英格兰相比,IMV的使用率明显更高.
- 在各国接受IMV的患者中观察到痴呆和透析依赖等并发症的差异.
结论:
- 在成年人IMV使用方面存在显著的国际差异,美国的IMV使用率远高于英国和加拿大.
- 在老年人群中,IMV使用的变化尤其明显,并且可能受到患者特征和并发症的影响.
- 这些发现强调了对患者,临床医生和卫生系统因素的进一步研究的需要,这些因素推动了这种关键,资源密集型干预的差异化使用.
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