Association between Participation in a Rehabilitation Program and 1-Year Survival in Patients Requiring Prolonged Mechanical Ventilation

Abstract

Background: The present study evaluated the association between participation in a rehabilitation program during a hospital stay and 1-year survival in patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]) whose main diagnosis leading to mechanical ventilation was various respiratory diseases.Methods: Retrospective data of 105 patients (71.4% male, mean age 70.1 ± 11.3 years) who received PMV in the past 5 years were analyzed. The rehabilitation program was defined as a physiotherapy, physical rehabilitation, and dysphagia treatment program that was individually provided by physiatrists.Results: The main diagnosis leading to mechanical ventilation was pneumonia (n=101, 96.2%) and the 1-year survival rate was 33.3% (n=35). One-year survivors had lower Acute Physiology and Chronic Health Evaluation (APACHE) II (20.2 ± 5.8 vs. 24.2 ± 7.5, p=0.006) and Sequential Organ Failure Assessment (6.7 ± 5.6 vs. 8.5 ± 2.7, p=0.001) scores at the day of intubation than non-survivors. More survivors participated in a rehabilitation program during their hospital stay (88.6% vs. 57.1%, p=0.001). The rehabilitation program was an independent factor for 1-year survival based on the Cox proportional hazard model (hazard ratio 3.513, 95% confidence interval 1.785-6.930, p<0.001) in patients with APACHE II scores ≤ 23 (cutoff based on Youden's index).Conclusion: Our study showed that participation in a rehabilitation program during the hospital stay was associated with an improvement of the 1-year survival of PMV patients who had less severe illness on day of intubation.