机械通风用于重症监护中的老年患者. 增量变化和收益的增加
I L Cohen1, J Lambrinos, I A Fein
1Department of Surgery, Albany Medical College, NY 12208.
JAMA
|February 24, 1993
概括
长时间的机械通风对于ICU中80岁以上的患者来说是不具有成本效益的,特别是当年龄加上通风天数超过100天时. 对医院费用和节省生命年数的分析为临床和行政决策提供了洞察力.
科学领域:
- 关键护理医学 关键护理医学
- 卫生经济学 卫生经济学
- 老年医学 老年医学
背景情况:
- 长时间的机械通风是重症监护室 (ICU) 的资源密集型干预措施.
- 在老年人群中评估此类干预措施的成本效益对于资源分配和临床决策至关重要.
- 80岁及以上的患者代表着一个不断增长的人口群体,具有独特的医疗保健需求和结果.
研究的目的:
- 评估长期机械通风在重症监护室 (ICU) 80岁及以上患者的成本效益.
- 为了确定与机械通风相关的财务影响和节省的生命年数,在这个特定的老年人群中.
- 提供数据,可以为临床和行政决策提供有关严重病情的老年患者通风策略的信息.
主要方法:
- 45名年龄在80岁以上的ICU患者的回顾性评估,需要机械通风至少3天.
- 基于增加的医院费用和节省的生命年数的成本效益分析.
- 通过电话调查,对医院幸存者进行至少4年的随访.
主要成果:
- 在45名患者中,只有10人幸存住院;只有一个人在随访时还活着.
- 估计每年节省生命的成本在51,854美元至75,090美元 (1985-1987美元) 之间.
- 对于年龄加上通风日超过100天的患者,每年挽救生命的成本为1,181,308美元,随访时没有幸存者.
结论:
- 80岁及以上的ICU患者长期使用机械通风的成本效益较低,特别是当年龄和通风持续时间的总和超过100时.
- 研究结果表明,目前针对这一群体的通风策略可能与经济效率或长期生存益处不一致.
- 建议进行进一步的成本效益分析,以指导临床和行政决策,管理需要机械通风的重病老年患者.
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