Mechanical ventilation in medical and neurological diseases: 11 years of experience

Abstract

Mechanical ventilation (MV) is imperative in many forms of acute respiratory failure (ARF). The aim of this work was to review all episodes of MV in a Medical Intensive Care Unit (MICU) during the 11-year period 1976-1986. Four per cent (n = 1008) of 24,899 admissions to the MICU were treated with MV. The mean age of ventilator-treated patients was 53 +/- 18 years, and obviously it increased during the period of study. The average duration of MV was 4.7 d. MICU mortality, hospital mortality and 2-year mortality rates for patients subjected to MV were 33%, 38% and 46%, respectively. The mortality rate did not change during the study period. Cerebrovascular and malignant diseases carried the highest mortality rates, 75 and 79%, respectively, whereas mortality in patients ventilated because of drug overdose (n = 313) was only 2%. The results of this study confirm previously published findings concerning the outcome of MV, and we conclude that the effects of MV remain discouraging in medical and neurological patients. Improved quality of ventilator therapy and monitoring, as well as continued research directed at the causes of ARF, are equally important in reducing the mortality in ARF.

Mechanical ventilation of the patient with severe chronic obstructive pulmonary disease

“…Weiss and Hudson [105] reviewed 11 studies with an average hospital mortality rate of 43 %. Two other studies reported ICU mortality of 27 % and a 1-year mortality of 62 % [104] and ICU mortality, hospital mortality and 2-year mortality rates of 50 %, 53 %, and 58 %, respectively [106]. These data are in keeping with a recent review of the APACHE III database which disclosed ICU, hospital and 1-year mortality rates of 16 %, 32 %, and 50 %, respectively [107].…”

“…However, such patients continue to have a high risk of further exacerbations, resulting in frequent admissions and mortality in excess of 50 % at I and 2 years [104][105][106][107][108].…”

Cost and Outcome of Mechanical Ventilation for Life-Threatening Stroke

“…[1][2][3][4][5][6][7][8][9][10] Variations in mortality between studies may result from differences in when and where the study was performed, patient demographics, criteria for and timing of intubation, access to ICU care, aggressiveness of medical management, and the frequency of withholding or withdrawing care. The highest mortality rates (Ͼ90%) were reported in an older study of patients treated between 1976 and 1986 7 and by a group who intubated only 2% of ischemic stroke patients and did not treat ventilated patients in an ICU.…”

“…Endotracheal intubation is often performed as a potentially life-saving intervention in stroke patients with depressed level of consciousness, airway compromise, or respiratory failure. However, the prognosis of stroke patients treated with MV is poor, with reported mortality rates of 49% to 93%, [1][2][3][4][5][6][7][8][9][10] and most survivors are severely disabled. Because care provided in intensive care units (ICUs) is expensive, these data have raised serious questions about the cost-effectiveness and cost-utility of MV for stroke.…”

A progressive care programme for prolonged ventilatory failure: analysis of outcome

“…The high survival rate in our study could also be related to the preponderance of patients with chronic obstructive lung disease and neuromuscular disorders. This seems unlikely however as in previous studies the prognosis worsened progressively from the group of subjects who had taken a drug overdose through postoperative patients, those with asthma, acute left ventricular failure, chronic airflow obstruction, neuromuscular disorders and skeletal deformity, cerebrovascular diseases and cancer, to those who required mechanical ventilation after cardiopulmonary resuscitation [8,10,12,17]. Our patients would therefore be expected to fall in the middle to poor range of expected survival from these composite series.…”