Long-term mortality and quality of life after prolonged mechanical ventilation*

Chelluri, Lakshmipathi; Im, Kyung Ah; Belle, Steven H.; Schulz, Richard; Rotondi, Armando J.; Donahoe, Michael P.; Sirio, Carl A.; Mendelsohn, Aaron B.; Pinsky, Michael R.

doi:10.1097/01.ccm.0000098029.65347.f9

Cited by 317 publications

(224 citation statements)

References 45 publications

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“…Over 27% of blacks believed that 50% or more of persons receiving this life-sustaining treatment were returned to their normal activities, compared to 17% of non-Hispanic whites. In reality, 56% of patients who require mechanical ventilation for 48 h or more are dead at 1 year, and almost 60% of the survivors require caregiver assistance at 1 year 32 . This, of course, is in stark contrast to the popular representations of life-sustaining treatments 33 .…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Differences in Preferences for End-of-Life Treatment

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Differences in Preferences for End-of-Life Treatment

et al. 2009

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“…The worse one-year mortality in the prolonged-weaning group is probably due to their higher hospital mortality. According to the literature, the oneyear mortality range in mechanically ventilated patients is 50 -70%, [26][27][28] and 63-78% in patients in weaning units. 29,30 These results confirm that mechanical ventilation weaning duration does not influence long-term outcome, as already suggested by Stauffer et al, 27 who found that long-term outcome was independent from overall ventilation duration.…”

Section: Discussionmentioning

confidence: 99%

Clinical Relevance of Classification According to Weaning Difficulty

Tonnelier

Nowak

et al. 2011

Respir Care

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OBJECTIVE: To evaluate the clinical relevance of the weaning from mechanical ventilation classification system derived from the 2005 international consensus conference, in patients who receive mechanical ventilation for more than 48 hours, and evaluate its correlation with prognosis. METH-ODS: We conducted a retrospective cohort study in a 12-bed intensive care unit (ICU) in a teaching hospital. We included patients who required > 48 hours of mechanical ventilation and who passed a spontaneous breathing trial (SBT). Weaning and sedation were monitored according to standardized protocol-directed procedures. We collected data on physiological characteristics, mechanical ventilation duration, ICU and hospital stay, and mortality from the medical records database. We assessed one-year mortality with a prospective, standardized method. Multivariate logistic regression was performed to evaluate the association between weaning categories and outcome. RE-SULTS: We included 329 ventilation episodes, in which 115 patients passed at least one SBT. Thirty-four patients (30%) succeeded in their first SBT (simple weaning group), 47 patients (40%) succeeded in their 2nd or 3rd SBT or in less than 7 days of weaning (the difficult weaning group), and 34 patients (30%) required more than 3 SBTs or more than 7 days of weaning (the prolonged weaning group). There were significant differences in ICU and hospital mortality between the simple, difficult, and prolonged-weaning groups. Prolonged weaning was an independent risk factor for longer ICU stay (odds ratio 15.11, 95% CI 1.61-141.91, P ‫؍‬ .01) and hospital mortality (odds ratio 3.66, 95% CI 0.99 -13.51). However, the weaning process did not impact one-year mortality (odds ratio 2.61, 95% CI 0.82-8.35). CONCLUSIONS: The new weaning classification system is clinically relevant and correlates to ICU and hospital mortality, but not to one-year mortality.

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“…Ventilación mecánica prolongada En la bibliografía, existe variabilidad para definir ventilación mecánica prolongada (VMP): ≥ 48 horas, 19 ≥ 96 horas, 20 ≥ 7 días, 21,22 y ≥ 21 días. 23 En este estudio, consideramos VMP al período de ARM igual a 7 días o mayor.…”

Section: 18unclassified