呼吸照護中心病人之身體質量指數與預後之關係

The Relationship between Body Mass Index and Prognosis in a Respiratory Care Center

陳欽明(Chin-Ming Chen) ； 宋美儀(Mei-Yi Sung) ； 鄭高珍(Kuo-Chen Cheng) ； 謝俊民(Jiunn-Min Shieh)

《中華民國急救加護醫學會雜誌》 16卷1期 (2005/03) Pp. 9-17

https://doi.org/10.30018/JECCM.200503.0002

摘要

Background: We attempted to investigate the relationship between the body mass index (BMO and the prognosis of patients with long-term mechanical ventilatory support in a respiratory care center (RCC) in southern Taiwan.
Methods: From July 2002 to October 2003, we retrospectively collected data from 348 patients with long-term mechanical ventilation support in an RCC of a medical center in southern Taiwan. All patients had been ventilator dependent for over 2] days in the intensive care unit (ICU) and RCC. We classified the causes of ventilator dependence, measured the BMI, and evaluated factors related to the prognosis, including the length of RCC stay, total hospital days (ICU+RCC days), ventilator weaning rate, and mortality rate. We also investigated whether the APACHE II score, age, and gender were correlated with successful weaning.
Results: Among the 348 ventilator-dependent patients, the most-common cause of respiratory failure was lung infection (167 cases, 48%), followed by an infection site other than the lungs (60 cases, 17.2%), decompensated heart disease (49 cases, 14.1%), neuromuscular disease (40 cases, 11.5%), chronic pulmonary diseases (26 cases, 7.5%), and others (6 cases, 1.7%). In total, 228 patients (65.5%) were successfully weaned from the ventilator (i.e., they were able to spontaneously breath without ventilator support for more than 5 days); those who were successfully weaned had lower APACHE II scores, and fewer ventilator days in the RCC, admission days in RCC, and total hospital days (all p＜0.00]). Women were more likely to have successfully been weaned from the ventilator (adjusted by multiple logistic regression, p＜0.03). When the BMI was divided into 3 groups (underweight, BMI＜ 18.5; normal, BMI 18. 524; and overweight, BMJ＞24), we found that the BMJ showed no statistical significance with respect to the weaning rate or mortality (p＞0.05), and the 3 groups had similar RCC admission days. However, when comparing the ventilator administration period in the ICU, we found that the period for the first group was signifIcantly shorter (16.35±5.53 vs. 19.57±9.56 vs. 21.45±8.96 days, respectively, p 0.009).
Conclusions: Patients with a low BMI (＜18.5) had significantly shorter stays in the ICU (with earlier transfer to the RCC). However, the BMI per se did not predict successful ventilator weaning or mortality in the RCC. Women and patients with lower APACHE II scores had higher incidences of successful weaning from the ventilator in the RCC.

關鍵字

身體質量指數 ； 呼吸器脫離 ； 呼吸衰竭 ； 預後

並列摘要

Background: We attempted to investigate the relationship between the body mass index (BMO and the prognosis of patients with long-term mechanical ventilatory support in a respiratory care center (RCC) in southern Taiwan.
Methods: From July 2002 to October 2003, we retrospectively collected data from 348 patients with long-term mechanical ventilation support in an RCC of a medical center in southern Taiwan. All patients had been ventilator dependent for over 2] days in the intensive care unit (ICU) and RCC. We classified the causes of ventilator dependence, measured the BMI, and evaluated factors related to the prognosis, including the length of RCC stay, total hospital days (ICU+RCC days), ventilator weaning rate, and mortality rate. We also investigated whether the APACHE II score, age, and gender were correlated with successful weaning.
Results: Among the 348 ventilator-dependent patients, the most-common cause of respiratory failure was lung infection (167 cases, 48%), followed by an infection site other than the lungs (60 cases, 17.2%), decompensated heart disease (49 cases, 14.1%), neuromuscular disease (40 cases, 11.5%), chronic pulmonary diseases (26 cases, 7.5%), and others (6 cases, 1.7%). In total, 228 patients (65.5%) were successfully weaned from the ventilator (i.e., they were able to spontaneously breath without ventilator support for more than 5 days); those who were successfully weaned had lower APACHE II scores, and fewer ventilator days in the RCC, admission days in RCC, and total hospital days (all p＜0.00]). Women were more likely to have successfully been weaned from the ventilator (adjusted by multiple logistic regression, p＜0.03). When the BMI was divided into 3 groups (underweight, BMI＜ 18.5; normal, BMI 18. 524; and overweight, BMJ＞24), we found that the BMJ showed no statistical significance with respect to the weaning rate or mortality (p＞0.05), and the 3 groups had similar RCC admission days. However, when comparing the ventilator administration period in the ICU, we found that the period for the first group was signifIcantly shorter (16.35±5.53 vs. 19.57±9.56 vs. 21.45±8.96 days, respectively, p 0.009).
Conclusions: Patients with a low BMI (＜18.5) had significantly shorter stays in the ICU (with earlier transfer to the RCC). However, the BMI per se did not predict successful ventilator weaning or mortality in the RCC. Women and patients with lower APACHE II scores had higher incidences of successful weaning from the ventilator in the RCC.

並列關鍵字

body mass index ； ventilator weaning ； respiratory insufficiency ； prognosis