【論文摘要】The Risk Factors of in-hospital mortality of Endotracheal Intubation Patients in a Southern Taiwan Hospital

【論文摘要】台灣南部某家醫院氣管內管插管病人之住院死亡的危險因素

鄭愛琴(AC Cheng) ； 陳欽明(CM Chen) ； 柯獻欽(SH Ko) ； 王嘉地(CT Wang) ； 徐怡強(YC Hsu) ； 柯順耀(SY Ko)

《呼吸治療》 17卷1期 (2018/07) Pp. 32-32

https://doi.org/10.6269/JRT.201807_17(1).0005

摘要

Introduction: At present, the costs of invasive mechanical ventilation by the endotracheal intubation accounts for the third in major injury-related injuries of National Health Insurance, and these medical expenses still can not be underestimated.This study is aimed to investigate the potential risk factors of patient’s in-hospital mortality with endotracheal intubation. Methods and Measurements: The medical records of all endotracheal intubation patients in intensive care units (ICUs) from 1 Jan, 2017 to 31 Dec, 2017 in a southern Taiwan hospital were retrospectively reviewed. Included criteria were age ≥20 years old. Excluded criteria were tracheostomy and double-lumen endotracheal intubation. Patient age, medical admission status, disease severity, GCS, ICU stay, on tracheostomy, the causes of intubation, the systems of respiratory failure and comorbidity status were investigated as potential risk factors. Successful weaning from mechanical ventilation was defined as without reintubation over 72 hours after endotracheal tube extubation. The stay time in hospital and their medical costs were also measured. Their relations to in-hospital mortality were accessed by mortality hazard ratio which is calculated by Cox's proportional hazards regression model. The difference of potential risk factors between survival and non-survival groups were also explored. Continuous and categorical data were separately tested by two sample t test and chi square test. Statistical significance was set at p＜0.05.. Statistical analysis of the data was done by SPSS version 18.0. Main Results: A total of 2381 patients with male predominant (63.2%, n=1505) were recruited. The mortality rate was 28.2% (n=672). Compared with the survival group, the non-survival group had a lower GCS, higher APACHE II, with cardiac comorbidity, with hepatic comorbidity, and re-intubation within 72 hours. The non-survival group had a longer ICU stay (12.1 vs. 7.7days, p＜0.001), and with a lower hospital stay (19.5 vs. 25.1 days, p＜0.001) but a trend of higher cost (39.7 vs. 36.5 x 104 New Taiwan Dollars, p=0.093). The results of cox proportional hazards regression model shown that older age (≥ 69.5years, hazard ratio (HR):1.24, 95% confidence interval(CI): 1.60-1.45,p=0.007), intubation due to surgery (HR:0.26, 95% CI: 0.21-0.33,p＜0.001), higher APHCHE II (≥ 24.5, HR:2.23, 95% CI: 1.90-2.62 ,p＜0.001), Pulmonary system respiratory failure (HR:1.25, 95% CI: 1.05-1.50,p=0.014), hepatic comorbidity (HR:1.65, 95% CI: 1.22-2.24,p=0.001), and Cardiac comorbidity (HR:1.47, 95% CI: 1.09-1.99,p=0.011), were correlated with higher risk of in-hospital mortality. Conclusion: Among those patient received endotracheal intubation, the non-survival group had a longer ICU stay, and lower hospital stay, but a trend of higher cost. Older age, lower intubation due to surgery, higher APHCHE II, pulmonary system respiratory failure, cardiac comorbidity and hepatic comorbidity of the patients increased the risk factors of in-hospital mortality.

關鍵字

endotracheal intubation ； in-hospital mortality ； APHCHE II ； intensive care unit.