Prediction of survival time after terminal extubation: the balance between critical care unit utilization and hospice medicine in the COVID-19 pandemic era

European Journal of Medical Research

Research

Ching-Fang Lai¹  Pin-Yuan Chen²  Yun-Cong Zheng³  Yu-Cheng Kao⁴  Wei-Siang Chen⁴  Chien-Hong Lai⁵  Ning-Yi Shih⁵  Yen-Min Huang⁶  Chien-Ming Chu⁷  Huang-Pin Wu⁸  Hsiao-Yean Chiu⁹ 

[1] Department of Social Services, Chang Gung Memorial Hospital, Keelung, Taiwan;Departments of Neurosurgery, Chang Gung Memorial Hospital, Keelung and Linkou & Chang Gung University, Taoyuan, Taiwan;Departments of Neurosurgery, Chang Gung Memorial Hospital, Keelung and Linkou & Chang Gung University, Taoyuan, Taiwan;Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan;Division of Cardiology Section, Internal Medicine, Chang Gung Memorial Hospital, Keelung & Chang Gung University, Taoyuan, Taiwan;Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., 204, Keelung, Taiwan;Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., 204, Keelung, Taiwan;Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan;Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, 20401, Keelung, Taiwan;Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, 20401, Keelung, Taiwan;College of Medicine, Chang Gung University, 33302, Taoyuan, Taiwan;School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan;Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan;

关键词: Terminal extubation;    APACHE II score;    Hospice medicine;    SpO2;    Intensive care unit;    COVID-19;   

DOI  :  10.1186/s40001-022-00972-w

 received in 2022-09-01, accepted in 2022-12-26,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundWe established 1-h and 1-day survival models after terminal extubation to optimize ventilator use and achieve a balance between critical care for COVID-19 and hospice medicine.MethodsData were obtained from patients with end-of-life status at terminal extubation from 2015 to 2020. The associations between APACHE II scores and parameters with survival time were analyzed. Parameters with a p-value ≤ 0.2 in univariate analysis were included in multivariate models. Cox proportional hazards regression analysis was used for the multivariate analysis of survival time at 1 h and 1 day.ResultsOf the 140 enrolled patients, 76 (54.3%) died within 1 h and 35 (25%) survived beyond 24 h. No spontaneous breathing trial (SBT) within the past 24 h, minute ventilation (MV) ≥ 12 L/min, and APACHE II score ≥ 25 were associated with shorter survival in the 1 h regression model. Lower MV, SpO2 ≥ 96% and SBT were related to longer survival in the 1-day model. Hospice medications did not influence survival time.ConclusionAn APACHE II score of ≥ 25 at 1 h and SpO2 ≥ 96% at 1 day were strong predictors of disposition of patients to intensivists. These factors can help to objectively tailor pathways for post-extubation transition and rapidly allocate intensive care unit resources without sacrificing the quality of palliative care in the era of COVID-19.Trial registration They study was retrospectively registered. IRB No.: 202101929B0.

【 授权许可】

CC BY   
© The Author(s) 2023

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