Surgery and procedures performed during hospitalization are recorded according to the Japanese fee schedule for reimbursement. Diagnoses are recorded using International Classification of Diseases, 10th revision, codes by attending physicians. The Japanese DPC database includes data on the following characteristics: age, sex, weight, admission and discharge status, main diagnosis, admission-precipitating diagnosis, resource-consuming diagnosis, comorbidities, complications, surgery, and procedures performed and medications administered during hospitalization. The DPC is a case-mix classification system that is linked with a lump-sum payment system for inpatient care reimbursement. This was a retrospective, case–control study using a nationwide inpatient database of acute care hospitals in Japan (i.e., the DPC database) to assess the efficacy of ECMO therapy for ARF in ILD patients treated between 20. The aim of this study was to elucidate the mortality rate and identify prognostic factors in these patients by using nationwide data from the Japanese Diagnosis Procedure Combination (DPC) database. Moreover, even in-hospital mortality and prognostic factors in ILD patients receiving ECMO have not been clarified. ![]() Due to difficulties in predicting the reversibility of respiratory failure, which arise from its heterogeneous causes, the indications for ECMO in ILD patients with ARF need to be discussed. Ever since ECMO therapy proved successful in influenza A (H1N1)-induced severe acute respiratory distress syndrome (ARDS), as well as severe adult respiratory failure (CESAR trial) in 2009, the use of ECMO for respiratory failure in adults has expanded rapidly.ĮCMO therapy is indicated in patients with potentially reversible causes of respiratory failure or those awaiting lung transplantation. ECMO enables lung-protective ventilation and reduces complications such as ventilator-induced lung injury and oxygen toxicity. Veno-venous ECMO serves as an artificial lung that provides oxygenation and removes carbon dioxide by draining and reinfusing the blood through cannulas located in central veins. Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support, is a life-saving procedure established for severe respiratory failure, cardiac shock, and cardiac arrest. Regardless of the type of interstitial lung disease (ILD), the associated acute respiratory failure (ARF) leads to a poor prognosis, especially in patients requiring invasive mechanical ventilation (IMV). Moreover, advanced age, non-use of macrolides, and use of antifungal drugs were found to correlate with a poor prognosis. ConclusionsĪpproximately three-quarters of interstitial lung disease patients undergoing extracorporeal membrane oxygenation died in hospital. On multivariate analysis, the following factors were associated with in-hospital mortality: advanced age (odds ratio 1.043 95% confidence interval 1.009–1.078), non-use of macrolides (OR 0.305 95% CI 0.134–0.698), and use of antifungal drugs (OR 2.416 95% CI 1.025–5.696). Compared with survivors, non-survivors were older and received high-dose cyclophosphamide, protease inhibitors, and antifungal drugs more frequently, but macrolides and anti-influenza drugs less frequently. ResultsĪ total of 164 interstitial lung disease patients receiving extracorporeal membrane oxygenation were included. To avoid selection biases, patients treated with extracorporeal membrane oxygenation as a bridge to lung transplantation were excluded. ![]() Patients’ characteristics and treatment regimens were compared between survivors and non-survivors to identify prognostic factors. In this case–control study using the Japanese Diagnosis Procedure Combination database, hospitalized interstitial lung disease patients receiving invasive mechanical ventilation and extracorporeal membrane oxygenation from 2010 to 2017 were reviewed. The objective of this study was to clarify in-hospital mortality and prognostic factors in interstitial lung disease patients undergoing extracorporeal membrane oxygenation. Consequently, indications for extracorporeal membrane oxygenation in these patients are still controversial, except as a bridge to lung transplantation. Whether acute respiratory failure in patients with interstitial lung disease is reversible remains uncertain.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |