Entwöhnung vom Respirator nach Langzeitbeatmung: Outcome langzeitbeatmeter Patienten
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Philipps-Universität Marburg
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Abstract
Weaning, hospital- and long-term survival as well as health related quality of life of long-term ventilated patients with underlying chronic respiratory disease was investigated in the presented study. It is the first study that investigated all these outcome parameters in the same patient-population.
The patient population (n = 403) mainly consisted of patients with chronic obstructive pulmonary disease (COPD, 59%), neuro-muscular diseases and restrictive ventilatory disorders. Patient s median age was 66 years, patients with neuro-muscular diseases being much younger than patients in the other diagnostic groups. After 33 days of mechanical ventilation in the referring intensive care units, 277 patients (69%) could be weaned from invasive mechanical ventilation.
Regarding weaning-success, an assumed disease-group-effect could be confirmed: Neuromuscular patients were less likely to be weaned than patients of the other diagnostic groups. The relation of predictive power of the ventilation parameters to the patient s diagnostic group, which was first described by Vallverdu et al. in 1998, could not be confirmed in the hole patient-collective but in the group of COPD patients. Only in COPD patients, tidalvolume of stable weaned patients was higher than of instable weaned or non-weanable patients. But main diagnostic group itself was the most important factor in prediction of weaning-success.
The importance of the clinical estimation of weaning-stability for patient s further prognosis was pointed out in relating weaning-stability to survival-rates: Clinically instable weaned patients had nearly the same bad hospital- and long-term survival-rates like non-weanable patients and differed significantly from the stable weaned patients. They were characterized by a clearly lower hospital survival-rate (58% versus 97%) and lower long-term survival-rates (26% versus 74%).
All together, weaning failure was the main risk-factor for in hospital-mortality. Only in the group of neuro-muscular patients, weaning failure did not increase the risk of death in hospital. Ventilation parameters did not influence patient s risk for hospital-mortality in the different diagnostic groups. At comparable hospital-mortality rates of the different diagnostic groups, a disease-group effect on long term-survival could be confirmed: Patients suffering from restrictive ventilatory disease and neuro-muscular diseases were characterized by higher means of survival-time than COPD-patients (27 and 27 versus 12 month). In contrast to suggestion, a relation of ventilation parameters at discharge and survival time could be detected: The patients showing the higher pO2, the lower pCO2 and the higher tidalvolume had a longer survival.
Using the Short Form-36 Health Questionnaire (SF-36) und des St. GeorgeŽs Respiratory Questionnaire (SGRQ) the presented study provides benchmark-data regarding general and health-related quality of life in former long-term ventilated patients with chronic respiratory diseases. At median of 14 month after discharge from hospital, mean quality of life of patients was significantly reduced when compared to norm collective, short-term ventilated patients and COPD-patients at stable stage of disease. While a relation between quality of life and patient s age was missing, there was a remarkable disease-group effect in quality of life: Restrictive ventilatory disease patients were characterized by higher quality of life than patients with COPD and neuro-muscular diseases. Like expected in advance, there was only a weak relation of ventilation parameters at discharge and quality of life. Merely FEV1%VC related to symptoms-score of SGRQ and physical component scale in SF-36.
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Created: 2004Issued: 2004-11-25Updated: 2011-08-10
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Chronisch obstructive LungenerkrankungHealth-related quality of lifeChronic obstructive pulmonary diseaseBeatmung, Respiratorentwöhnung, Lebensqualität, LangzeitüberlebenSurvivalLong-term mechanical ventilationWeaning
DFG-subjects
LebensqualitätÜberlebenKünstliche Beatmung
DDC-Numbers
610
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Euteneuer, Sara: Entwöhnung vom Respirator nach Langzeitbeatmung: Outcome langzeitbeatmeter Patienten. : Philipps-Universität Marburg 2004-11-25. DOI: https://doi.org/10.17192/z2004.0621.
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This item has been published with the following license: In Copyright