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Lai HH, Tseng PY, Wang CY, Wang JY. Long-Term Survival and Medical Costs of Patients with Prolonged Mechanical Ventilation and Tracheostomy: A Nationwide Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910272. [PMID: 34639575 PMCID: PMC8507749 DOI: 10.3390/ijerph181910272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 12/15/2022]
Abstract
Few large-scale studies have focused on tracheostomy in patients with prolonged mechanical ventilation. This retrospective population-based study extracted data from the longitudinal National Health Insurance Research Database in Taiwan to compare long-term mortality between patients on prolonged mechanical ventilation with and without tracheostomy and their related medical expenditures. Data on newly developed respiratory failure in patients on ventilator support were extracted from 1 January 2002 to 31 December 2008. Of 10,705 patients included, 1372 underwent tracheostomy (n = 563) or translaryngeal intubation (n = 779). Overall survival of the patients with tracheostomy was followed for 5 years. Average survival was 4.98 years for the patients with tracheostomy and 5.48 years for the patients with translaryngeal intubation (not significant). Sex, age, premium-based monthly salary difference, occupation, urbanization level, chronic obstructive pulmonary disease, chronic heart failure, chronic renal disease, and cerebrovascular diseases were significantly associated with mortality for endotracheal intubation. Male sex, chronic heart failure, chronic renal disease, age ≥45 years, and low income were associated with significantly higher mortality. Although total medical expenditures were higher for the patients with tracheostomy, annual medical expenditures were not significantly different. There were no differences in long-term mortality between the two groups.
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Affiliation(s)
- Hui-Hsuan Lai
- Department of Nursing, China Medical University Hospital, Taichung 404332, Taiwan;
| | - Pei-Ying Tseng
- Department of Public Health, China Medical University, Taichung 406040, Taiwan;
- Department of Medical, Lee’s General Hospital, Yuanli Town, Miaoli 358011, Taiwan
| | - Chen-Yu Wang
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 407752, Taiwan;
- Department of Nursing, Hungkuang University, Taichung 433304, Taiwan
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan
- Correspondence: ; Tel.: +886-4-2296-7979 (ext. 6313)
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Chang KW, Leu SW, Lin SW, Liang SJ, Yang KY, Chan MC, Chen WC, Hu HC, Fang WF, Chen YM, Sheu CC, Tsai MJ, Wang HC, Chien YC, Peng CK, Wu CL, Kao KC. Renal Replacement Therapy in Patients with Influenza Pneumonia Related Acute Respiratory Distress Syndrome. J Clin Med 2021; 10:jcm10091837. [PMID: 33922592 PMCID: PMC8122892 DOI: 10.3390/jcm10091837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Acute kidney injury (AKI) requiring renal replacement therapy (RRT) increases the mortality of acute respiratory distress syndrome (ARDS) patients. The aim of this study was to investigate the outcomes and predictors of RRT in patients with influenza pneumonia-related ARDS. This retrospective cohort study includes patients from eight tertiary referral centers in Taiwan between January and March 2016, and all 282 patients with influenza pneumonia-related ARDS were enrolled. Thirty-four patients suffered from AKI requiring RRT, while 16 patients had underlying end stage renal disease (ESRD). The 30- and 60-day mortality rates were significantly higher in patients with AKI requiring RRT compared with those not requiring RRT (50.0% vs. 19.8%, p value < 0.001; 58.8% vs. 27.2%, p value = 0.001, respectively), but the patients with ESRD had no significant difference in mortality (12.5% vs. 19.8%, p value = 0.744; 31.3% vs. 27.2%, p value = 0.773, respectively). The predictors for AKI requiring RRT included underlying chronic liver disease and C-reactive protein. The mortality predictors for patients with AKI requiring RRT included the pneumonia severity index, tidal volume, and continuous renal replacement therapy. In this study, patients with influenza pneumonia-related ARDS with AKI requiring RRT had significantly higher mortality compared with other patients.
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Affiliation(s)
- Ko-Wei Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-W.C.); (S.-W.L.); (S.-W.L.); (H.-C.H.)
| | - Shaw-Woei Leu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-W.C.); (S.-W.L.); (S.-W.L.); (H.-C.H.)
| | - Shih-Wei Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-W.C.); (S.-W.L.); (S.-W.L.); (H.-C.H.)
| | - Shinn-Jye Liang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan;
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 122, Taiwan; (K.-Y.Y.); (W.-C.C.)
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei 122, Taiwan
| | - Ming-Cheng Chan
- Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan;
- College of Science, Tunghai University, Taichung 407, Taiwan
| | - Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 122, Taiwan; (K.-Y.Y.); (W.-C.C.)
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei 122, Taiwan
| | - Han-Chung Hu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-W.C.); (S.-W.L.); (S.-W.L.); (H.-C.H.)
- Department of Respiratory Therapy, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
| | - Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (W.-F.F.); (Y.-M.C.)
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
| | - Yu-Mu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (W.-F.F.); (Y.-M.C.)
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (C.-C.S.); (M.-J.T.)
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (C.-C.S.); (M.-J.T.)
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hao-Chien Wang
- Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (H.-C.W.); (Y.-C.C.)
| | - Ying-Chun Chien
- Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (H.-C.W.); (Y.-C.C.)
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Chieh-Liang Wu
- Center for Quality Management, Taichung Veterans General Hospital, Taichung 407, Taiwan;
- Office of Medical Administration, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Kuo-Chin Kao
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-W.C.); (S.-W.L.); (S.-W.L.); (H.-C.H.)
- Department of Respiratory Therapy, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
- Correspondence:
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Withana Gamage PW, Chaudari M, McMahan CS, Kim EH, Kosorok MR. An extended proportional hazards model for interval-censored data subject to instantaneous failures. LIFETIME DATA ANALYSIS 2020; 26:158-182. [PMID: 30796598 PMCID: PMC6707903 DOI: 10.1007/s10985-019-09467-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 02/11/2019] [Indexed: 06/09/2023]
Abstract
The proportional hazards (PH) model is arguably one of the most popular models used to analyze time to event data arising from clinical trials and longitudinal studies. In many such studies, the event time is not directly observed but is known relative to periodic examination times; i.e., practitioners observe either current status or interval-censored data. The analysis of data of this structure is often fraught with many difficulties since the event time of interest is unobserved. Further exacerbating this issue, in some such studies the observed data also consists of instantaneous failures; i.e., the event times for several study units coincide exactly with the time at which the study begins. In light of these difficulties, this work focuses on developing a mixture model, under the PH assumptions, which can be used to analyze interval-censored data subject to instantaneous failures. To allow for modeling flexibility, two methods of estimating the unknown cumulative baseline hazard function are proposed; a fully parametric and a monotone spline representation are considered. Through a novel data augmentation procedure involving latent Poisson random variables, an expectation-maximization (EM) algorithm is developed to complete model fitting. The resulting EM algorithm is easy to implement and is computationally efficient. Moreover, through extensive simulation studies the proposed approach is shown to provide both reliable estimation and inference. The motivation for this work arises from a randomized clinical trial aimed at assessing the effectiveness of a new peanut allergen treatment in attaining sustained unresponsiveness in children.
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Affiliation(s)
| | - Monica Chaudari
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Christopher S McMahan
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC, 29634, USA.
| | - Edwin H Kim
- Division of Rheumatology, Allergy and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Lai CC, Tseng KL, Ho CH, Chiang SR, Chen CM, Chan KS, Chao CM, Hsing SC, Cheng KC. Prognosis of patients with acute respiratory failure and prolonged intensive care unit stay. J Thorac Dis 2019; 11:2051-2057. [PMID: 31285898 DOI: 10.21037/jtd.2019.04.84] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Reasons for the prolonged critical care support include uncertainty of outcome, the complex dynamic created between physicians with care team members and the patient's family over a general unwillingness to surrender to unfavorable outcomes. The purpose of this study was to investigate outcomes and identify risk factors of patients with acute respiratory failure (ARF) who required a prolonged intensive care unit (ICU) stay (≥21 days). It may provide reference to screen patients who are suitable for hospice care. Methods The medical records of all ARF patients with a prolonged ICU stay were retrospectively reviewed. The primary outcome was in-hospital mortality. Results We identified 1,189 patients. Sepsis (n=896, 75.4%) was the most common cause of prolonged ICU stays, following by renal failure (n=232, 19.5%), and unstable hemodynamic status vasopressors or arrhythmia (n=208, 17.5%). Using multivariable logistic regression, we identified eight risk factors of death: age >75 years, ICU stay for more than 28 days, APACHE II score ≥25, unstable hemodynamic status, renal failure, hepatic failure, massive gastrointestinal tract bleeding, and using a fraction of inspired oxygen (FiO2) ≥40%. The overall in-hospital mortality rate was 53.6% (n=637), and it up to 75.3% (216/287) for patients with at least three risk factors. Conclusions The outcome of patients with ARF who required prolonged ICU stay was poor. They had a high risk of in-hospital mortality. Palliative care should be considered as a reasonable option for the patients at high risk of death.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan
| | - Kuei-Ling Tseng
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science, Tainan
| | - Shyh-Ren Chiang
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science, Tainan
| | - Chin-Ming Chen
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science, Tainan.,Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan
| | - Khee-Siang Chan
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan
| | - Shu-Chen Hsing
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan
| | - Kuo-Chen Cheng
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan.,Department of Safety Health and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan
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Chao CM, Sung MI, Cheng KC, Lai CC, Chan KS, Cheng AC, Hsing SC, Chen CM. Prognostic factors and outcomes of unplanned extubation. Sci Rep 2017; 7:8636. [PMID: 28819204 PMCID: PMC5561237 DOI: 10.1038/s41598-017-08867-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/30/2017] [Indexed: 12/22/2022] Open
Abstract
This study investigated the prognostic factors and outcomes of unplanned extubation (UE) in patients in a medical center’s 6 intensive care units (ICUs) and calculated their mortality risk. We retrospectively reviewed the medical records of all adult patients in Chi Mei Medical Center who underwent UE between 2009 and 2015. During the study period, there were 305 episodes of UE in 295 ICU patients (men: 199 [67.5%]; mean age: 65.7 years; age range: 18–94 years). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 16.4, mean therapeutic intervention scoring system (TISS) score was 26.5, and mean Glasgow coma scale score was 10.4. One hundred thirty-six patients (46.1%) were re-intubated within 48 h. Forty-five died (mortality rate: 15.3%). Multivariate analyses showed 5 risk factors—respiratory rate, APACHE II score, uremia, liver cirrhosis, and weaning status—were independently associated with mortality. In conclusion, five risk factors including a high respiratory rate before UE, high APACHE II score, uremia, liver cirrhosis, and not in the process of being weaned—were associated with high mortality in patients who underwent UE.
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Affiliation(s)
- Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan
| | - Mei-I Sung
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Kuo-Chen Cheng
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Safety, Health, and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan
| | - Khee-Siang Chan
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ai-Chin Cheng
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Shu-Chen Hsing
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chin-Ming Chen
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan. .,Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy & Science, Tainan, Taiwan.
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Lynch RJ, Zhang R, Patzer RE, Larsen CP, Adams AB. First-Year Waitlist Hospitalization and Subsequent Waitlist and Transplant Outcome. Am J Transplant 2017; 17:1031-1041. [PMID: 27664797 DOI: 10.1111/ajt.14061] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 01/25/2023]
Abstract
Frailty is associated with inferior survival and increased resource requirements among kidney transplant candidates, but assessments are time-intensive and costly and require direct patient interaction. Waitlist hospitalization may be a proxy for patient fitness and could help those at risk of poor outcomes. We examined United States Renal Data System data from 51 111 adult end-stage renal disease patients with continuous Medicare coverage who were waitlisted for transplant from January 2000 to December 2011. Heavily admitted patients had higher subsequent resource requirements, increased waitlist mortality and decreased likelihood of transplant (death after listing: 1-7 days: hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.20-1.28; 8-14 days: HR 1.49, 95% CI 1.42-1.56; ≥15 days: HR 2.07, 95% CI 1.99-2.15; vs. 0 days). Graft and recipient survival was inferior, with higher admissions, although survival benefit was preserved. A model including waitlist admissions alone performed better (C statistic 0.76, 95% CI 0.74-0.80) in predicting postlisting mortality than estimated posttransplant survival (C statistic 0.69, 95% CI 0.67-0.73). Although those with a heavy burden of admissions may still benefit from kidney transplant, less utility is derived from allografts placed in this population. Current kidney allocation policy, which is based in part on longevity matching, could be significantly improved by consideration of hospitalization records of transplant candidates.
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Affiliation(s)
- R J Lynch
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - R Zhang
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - R E Patzer
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - C P Larsen
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - A B Adams
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA
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Lai CC, Ho CH, Cheng KC, Chao CM, Chen CM, Chou W. Effect of liver cirrhosis on long-term outcomes after acute respiratory failure: A population-based study. World J Gastroenterol 2017; 23:2201-2208. [PMID: 28405148 PMCID: PMC5374132 DOI: 10.3748/wjg.v23.i12.2201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/02/2017] [Accepted: 03/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assessed the effect of liver cirrhosis (LC) on the poorly understood long-term mortality risk after first-ever mechanical ventilation (1-MV) for acute respiratory failure.
METHODS All patients in Taiwan given a 1-MV between 1997 and 2013 were identified in Taiwan’s Longitudinal Health Insurance Database 2000. Each patient with LC was individually matched, using a propensity-score method, to two patients without LC. The primary outcome was death after a 1-MV.
RESULTS A total of 16653 patients were enrolled: 5551 LC-positive (LC[Pos]) patients, including 1732 with cryptogenic LCs and 11102 LC-negative (LC[Neg]) controls. LC[Pos] patients had more organ failures and were more likely to be admitted to medical department than were LC[Neg] controls. LC[Pos] patients had a significantly lower survival rate (AHR = 1.38, 95%CI: 1.32-1.44). Moreover, the mortality risk was significantly higher for patients with non-cryptogenic LC than for patients with cryptogenic LC (AHR = 1.43, 95%CI: 1.32-1.54) and patients without LC (AHR = 1.56, 95%CI: 1.32-1.54). However, there was no significant difference between patients with cryptogenic and without LC (HR = 1.05, 95%CI: 0.98-1.12).
CONCLUSION LC, especially non-cryptogenic LC, significantly increases the risk of death after a 1-MV.
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