{"title":"日本icu与普通病房机械通气儿童的患者背景和结果：一项使用国家住院患者数据库的回顾性队列研究。","authors":"Yoshio Sakurai, Nobuaki Michihata, Kohei Osada, Shingo Kobayashi, Wataru Sakamoto, Yuta Uchida, Kuniya Ishii, Hiroya Yokohari, Hiroshi Kurosawa, Toshiaki Isogai, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga","doi":"10.1097/CCM.0000000000006901","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>In western countries, adult and pediatric patients requiring mechanical ventilation are treated in ICUs. However, in Japan, there is concern that many children on mechanical ventilation are being treated in general wards. This study aimed to compare patient characteristics and treatment outcomes between mechanically ventilated children in general wards and ICUs using a national inpatient database in Japan.</p><p><strong>Design: </strong>A retrospective cohort study using a national inpatient database.</p><p><strong>Setting: </strong>The study was carried out using a national inpatient database in Japan between July 2010 and March 2022, which includes data from multiple hospitals across the country. Patient characteristics were compared between patients in general wards and ICUs. We performed a 1:1 propensity score matching to compare in-hospital mortality between the groups.</p><p><strong>Patients: </strong>A total of 129,375 mechanically ventilated children 14 years old or younger who were hospitalized in general wards or ICUs were included in the study.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>During the study period, we identified 129,375 eligible patients. Of these, 63% of all patients, 78% of nonoperative patients, and 17% of postoperative patients were treated in general wards. Overall, 56% of the 48,137 ICU patients were postoperative and 70% of them underwent cardiac surgery. The one-to-one propensity score matching created 15,760 pairs, and in-hospital mortality was significantly higher in general ward patients than in ICU patients (6.4% vs. 4.1%; odds ratio, 1.49; 95% CI, 1.35-1.65; p < 0.001).</p><p><strong>Conclusions: </strong>Most of the children on mechanical ventilation in Japan were treated in general wards. The treatment of patients in general wards was associated with higher mortality than in ICUs, suggesting the need to centralize the care for mechanically ventilated pediatric patients in ICUs.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Patient Backgrounds and Outcomes of Mechanically Ventilated Children Treated in ICUs Versus General Wards in Japan: A Retrospective Cohort Study Using a National Inpatient Database.\",\"authors\":\"Yoshio Sakurai, Nobuaki Michihata, Kohei Osada, Shingo Kobayashi, Wataru Sakamoto, Yuta Uchida, Kuniya Ishii, Hiroya Yokohari, Hiroshi Kurosawa, Toshiaki Isogai, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga\",\"doi\":\"10.1097/CCM.0000000000006901\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>In western countries, adult and pediatric patients requiring mechanical ventilation are treated in ICUs. However, in Japan, there is concern that many children on mechanical ventilation are being treated in general wards. This study aimed to compare patient characteristics and treatment outcomes between mechanically ventilated children in general wards and ICUs using a national inpatient database in Japan.</p><p><strong>Design: </strong>A retrospective cohort study using a national inpatient database.</p><p><strong>Setting: </strong>The study was carried out using a national inpatient database in Japan between July 2010 and March 2022, which includes data from multiple hospitals across the country. Patient characteristics were compared between patients in general wards and ICUs. We performed a 1:1 propensity score matching to compare in-hospital mortality between the groups.</p><p><strong>Patients: </strong>A total of 129,375 mechanically ventilated children 14 years old or younger who were hospitalized in general wards or ICUs were included in the study.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>During the study period, we identified 129,375 eligible patients. Of these, 63% of all patients, 78% of nonoperative patients, and 17% of postoperative patients were treated in general wards. Overall, 56% of the 48,137 ICU patients were postoperative and 70% of them underwent cardiac surgery. The one-to-one propensity score matching created 15,760 pairs, and in-hospital mortality was significantly higher in general ward patients than in ICU patients (6.4% vs. 4.1%; odds ratio, 1.49; 95% CI, 1.35-1.65; p < 0.001).</p><p><strong>Conclusions: </strong>Most of the children on mechanical ventilation in Japan were treated in general wards. The treatment of patients in general wards was associated with higher mortality than in ICUs, suggesting the need to centralize the care for mechanically ventilated pediatric patients in ICUs.</p>\",\"PeriodicalId\":10765,\"journal\":{\"name\":\"Critical Care Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":6.0000,\"publicationDate\":\"2025-10-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/CCM.0000000000006901\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/CCM.0000000000006901","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
目的：在西方国家，需要机械通气的成人和儿童患者在icu接受治疗。然而，在日本，人们担心许多使用机械通气的儿童在普通病房接受治疗。本研究旨在利用日本国家住院患者数据库比较普通病房和icu机械通气儿童的患者特征和治疗结果。设计：使用国家住院病人数据库的回顾性队列研究。环境：该研究是在2010年7月至2022年3月期间使用日本的国家住院患者数据库进行的，其中包括来自全国多家医院的数据。比较普通病房和icu患者的患者特征。我们进行了1:1的倾向评分匹配来比较两组之间的住院死亡率。患者：共有129375名14岁及以下在普通病房或icu住院的机械通气儿童被纳入研究。干预措施:没有。测量和主要结果：在研究期间，我们确定了129375名符合条件的患者。其中，63%的患者、78%的非手术患者和17%的术后患者在普通病房接受治疗。总体而言，48137例ICU患者中56%为术后患者，其中70%为心脏手术患者。一对一倾向评分匹配产生了15,760对，普通病房患者的住院死亡率显著高于ICU患者（6.4% vs. 4.1%；优势比为1.49；95% CI为1.35-1.65;p < 0.001）。结论：日本机械通气患儿以普通病房为主。普通病房患者的治疗与icu患者的死亡率相关，提示需要对icu中机械通气的儿科患者进行集中护理。
Patient Backgrounds and Outcomes of Mechanically Ventilated Children Treated in ICUs Versus General Wards in Japan: A Retrospective Cohort Study Using a National Inpatient Database.
Objectives: In western countries, adult and pediatric patients requiring mechanical ventilation are treated in ICUs. However, in Japan, there is concern that many children on mechanical ventilation are being treated in general wards. This study aimed to compare patient characteristics and treatment outcomes between mechanically ventilated children in general wards and ICUs using a national inpatient database in Japan.
Design: A retrospective cohort study using a national inpatient database.
Setting: The study was carried out using a national inpatient database in Japan between July 2010 and March 2022, which includes data from multiple hospitals across the country. Patient characteristics were compared between patients in general wards and ICUs. We performed a 1:1 propensity score matching to compare in-hospital mortality between the groups.
Patients: A total of 129,375 mechanically ventilated children 14 years old or younger who were hospitalized in general wards or ICUs were included in the study.
Interventions: None.
Measurements and main results: During the study period, we identified 129,375 eligible patients. Of these, 63% of all patients, 78% of nonoperative patients, and 17% of postoperative patients were treated in general wards. Overall, 56% of the 48,137 ICU patients were postoperative and 70% of them underwent cardiac surgery. The one-to-one propensity score matching created 15,760 pairs, and in-hospital mortality was significantly higher in general ward patients than in ICU patients (6.4% vs. 4.1%; odds ratio, 1.49; 95% CI, 1.35-1.65; p < 0.001).
Conclusions: Most of the children on mechanical ventilation in Japan were treated in general wards. The treatment of patients in general wards was associated with higher mortality than in ICUs, suggesting the need to centralize the care for mechanically ventilated pediatric patients in ICUs.
期刊介绍：
Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient.
Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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