Long-Term Outcome after Prolonged Mechanical Ventilation. A Long-Term Acute-Care Hospital Study

Jubran, Amal; Grant, Brydon J. B.; Duffner, Lisa A.; Collins, Eileen G.; Lanuza, Dorothy M.; Hoffman, Leslie A.; Tobin, Martin J.

doi:10.1164/rccm.201806-1131oc

Cited by 67 publications

(80 citation statements)

References 66 publications

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“…We found a 1-year survival rate of RCW patients of 31.7%; this rate, too, was lower than that of discharged PMV patients. Jubran and colleagues reported a 1-year survival rate of16.4% for ventilator-attached patients (similar to our RCW patients) and 66.9% for ventilator-detached patients (similar to our discharged PMV patients)[18]. Clearly, weaning from the ventilator is important for long-term survival in PMV patients.…”

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confidence: 76%

A retrospective clinical observation of long-term survival in patients after prolonged mechanical ventilation

Huang¹

2020

Preprint

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Background The 1-year survival rate of patients on prolonged mechanical ventilation was 29-42% before 2000. By 2012, Carson reported the 1-year survival rate of prolonged mechanical ventilation patients was 52%, an unsatisfactory improvement in survival time. We explored the long-term survival rate of prolonged mechanical ventilation patients at our hospital, 2012-2017. Methods We analyzed retrospectively data from our respiratory care center patients to investigate the discharge status, long-term survival rate, and cause of death. We also compared the 5-year survival rates of prolonged mechanical ventilation patients and our hospital lung cancer patients. Results Five hundred seventy-four patients were admitted to respiratory care center during the study period. The long-term follow-up data of 403 prolonged mechanical ventilation, including 186 patients died in the hospital, 157 discharged prolonged mechanical ventilation patients, and 60 respiratory care ward patients until October 30, 2018. The 1-year survival rate of all prolonged mechanical ventilation patients, discharged prolonged mechanical ventilation patients, and respiratory care ward patients were 24.3%, 50.3%, and 31.7%, respectively. The 5-year survival rates of all prolonged mechanical ventilation patients, discharged prolonged mechanical ventilation patients, and respiratory care ward patients were 18.1%, 40.05%, and 11.7%, respectively. Successful weaning from mechanical ventilation was a key factor in the long-term survival of prolonged mechanical ventilation patients. The 5-year survival rate of discharged prolonged mechanical ventilation patients was better than that of all lung cancer patients. The 5-year survival rates of all prolonged mechanical ventilation patients and respiratory care ward patients were similar to that of stage IV lung cancer patients. Conclusions Prolonged mechanical ventilation patients had the worst long-term survival rate of all patients with chest diseases in our hospital. Successful weaning from the mechanical ventilator was most important factors for improving long-term outcomes in prolonged mechanical ventilation patients.

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confidence: 76%

A retrospective clinical observation of long-term survival in patients after prolonged mechanical ventilation

Huang¹

2020

Preprint

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“…This result means that, at most, 66.7% of the survivors were willing to receive mechanical ventilation again. In Jubran's series, 84.7% of survivors indicated a willingness to undergo mechanical ventilation again [21]. Our patients were less willing to receive second mechanical ventilation than were Jubran's patients.…”

Section: End-of-life Decisions In Successfully Weaned Pmv Patientsmentioning

confidence: 57%

The long term survival of successfully weaned prolonged mechanical ventilation patients

Huang¹

2020

Preprint

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KEYWORDSlong term survival, successfully weaned prolonged mechanical ventilation patients 2 Abstract Background Over six years, five hundred and seventy-four patients were admitted to the respiratory care center. Three hundred and ninety-one patients were successfully weaned from the ventilator.How is the long term outcome of these successfully weaned prolonged mechanical ventilation patients? Very few articles were discussing the long term outcome of successfully weaned prolonged mechanical ventilation patients. We will explore this issue in-depth in this article. MethodsWe analyzed retrospective data from successfully weaned prolonged mechanical ventilation patients to investigate the clinical variables, discharged status, long term survival, the cause of death, end-of-life decisions. Results We can further gather long term follow-up data on 243 patients. The factors between patients who died in the ward and those who survived ≥1 year revealed the poorer survival of patients who died in the ward was due to a higher percentage of end-stage renal disease comorbidity, a higher percentage of malignant comorbidity, higher percentage of ≥ four comorbidities and a higher percentage of signed do-not-resuscitate / do-not-intubate orders. The factors between patients who survived <1 year and those who survived ≥1 year revealed the poorer survival of patients who survived <1 year was due to older age, a higher percentage of signed do-not-resuscitate / do-notintubate orders. That 81 patients (33.3%) who signed a do-not-resuscitate / do-not-intubate orders, indicates that, at most, 66.7% of survivors were willing to receive mechanical ventilation again. Conclusion The end-of-life decision (signed do-not-resuscitate / do-not-intubate orders) is one of the major influence factors of long term survival of successfully weaned prolonged mechanical ventilation patients. In all, 81 patients (33.3%) in our study signed do-not-resuscitate / do-not-intubate orders, meaning that, at most, 66.7% of survivors were willing to receive mechanical ventilation again.

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“…Soweit bei der kurzen Laufzeit des Projektes zu beurteilen, ist die Sterblichkeit der von uns betreuten Patienten hoch. Dies entspricht Daten aus dem WeanNet sowie internationalen Erfahrungen 5 9 . Patienten mit schwerer, chronischer Erkrankung sterben oft an den Folgen ihrer Erkrankung.…”

Section: Diskussionunclassified

Vertrag zur prolongierten Beatmungsentwöhnung der AOK Hessen-Methodik und erste Erfahrungen

Giese

Blau²,

Knüppel

et al. 2020

Dtsch Med Wochenschr

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Zusammenfassung Hintergrund Die Zahl der Patienten, die im Verlauf einer intensivmedizinischen Behandlung von einer invasiven Beatmung entwöhnt werden müssen, hat in den vergangenen Jahren stetig zugenommen. Ein Teil hiervon bleibt dauerhaft beatmet und muss im ambulanten Bereich betreut werden. Das Gros dieser Patienten ist allerdings nicht in einem erfahrenen Weaningzentrum behandelt worden. Es ist daher wahrscheinlich, dass noch „Weaningpotenzial“ bei einem Teil der Patienten besteht. Methoden Die AOK Hessen hat nach umfangreicher Analyse Ansatzpunkte zur Verbesserung dieser Situation entwickelt, die hier erstmalig vorgestellt werden. Als wesentlich wurden die fachliche Expertise der das Potenzial einschätzenden Ärzte (Weanigerfahrung bzw. Weaningzentrum), die Option der temporären Unterbringung der Patienten in den neu zu schaffenden Therapiezentren für außerklinische Beatmung (TAB) und die strukturierte ambulante Nachsorge erkannt. Ergebnisse Bei den TAB handelt es sich um extrastationäre Einheiten, welche einem Weaningzentrum angeschlossen sind. Hier sollen Patienten in wohnlicher Atmosphäre betreut werden, bei denen es bisher nicht gelang, sie von der Invasivbeatmung zu entwöhnen. Der Fokus liegt dabei auf der täglichen physiotherapeutischen und logopädischen Arbeit. Hierfür wird ein Zeitraum von bis zu 6 Monaten ermöglicht, in dem sich die muskuläre und kognitive Situation verbessern soll. Im Anschluss wird dann je nach Verlauf ein erneuter Weaningversuch im Weaningzentrum unternommen. Diskussion Das Konzept wird im folgenden Artikel ausführlich beschrieben. Erste Erfahrungen zeigen den relevanten Stellenwert der TAB in der Entwöhnung von der Beatmung.

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Long-Term Outcome after Prolonged Mechanical Ventilation. A Long-Term Acute-Care Hospital Study

Cited by 67 publications

References 66 publications

A retrospective clinical observation of long-term survival in patients after prolonged mechanical ventilation

A retrospective clinical observation of long-term survival in patients after prolonged mechanical ventilation

The long term survival of successfully weaned prolonged mechanical ventilation patients

Vertrag zur prolongierten Beatmungsentwöhnung der AOK Hessen-Methodik und erste Erfahrungen

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