Outcomes of Prolonged Mechanical Ventilation Before and After Implementation of a Respiratory ICU

Herer, Bertrand

doi:10.4187/respcare.07093

Cited by 4 publications

(4 citation statements)

References 39 publications

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“…Subsequently, we aimed at identifying potential underlying factors which contributed to an impaired OS in patients with an unfavorable body composition. As the time of mechanical ventilation on the ICU is a well-established prognostic factor for OS ( 10 ), we correlated the MMA with the duration of ventilation and observed a significant negative correlation between the HU and the total hours of mechanical ventilation on the ICU ( Fig. 3 A ).…”

Section: Resultsmentioning

confidence: 99%

Skeletal Muscle Composition Predicts Outcome in Critically Ill Patients

Loosen

Schulze-Hagen

Püngel

et al. 2020

Critical Care Explorations

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Section: Resultsmentioning

confidence: 99%

Skeletal Muscle Composition Predicts Outcome in Critically Ill Patients

Loosen

Schulze-Hagen

Püngel

et al. 2020

Critical Care Explorations

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“…Sobotka et al (22) found that more than half of the delayed discharges of children with prolonged mechanical ventilation were caused by a lack of professional or home care after discharge. Studies conducted in Europe, the US, and Taiwan have shown that the establishment of stepped up nursing units and weaning centers was an advantage to the weaning and nursing care of patients dependent on ventilators and the rational utilization of medical resources (6,8,(27)(28)(29)(30). A study in the United States showed that patients with home mechanical ventilation (HMV) had a lower rate of depression, pressure ulcers, and mortality patients in hospital long-term care (HLTC).…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Risk Factors of Children Requiring Prolonged Mechanical Ventilation vs. Non-prolonged Mechanical Ventilation in the PICU: A Prospective Single-Center Study

Liu

Wang

et al. 2022

Front. Pediatr.

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BackgroundProlonged mechanical ventilation (PMV) has become an enormous challenge in intensive care units (ICUs) around the world. Patients treated with PMV are generally in poor health. These patients represent a select cohort with significant morbidity, mortality, and resource utilization. The status of children who have undergone PMV in China is unknown. Our goal is to investigate the prevalence and characteristics of pediatric patients with PMV, as well as the risk factors of PMV in the pediatric intensive care unit (PICU).MethodsThe subjects were divided into two groups. The PMV group(MV ≥ 14 days) and the non-PMV group(2 days < MV <14 days). The baseline characteristics, treatments, mortality and other results between the two groups were compared. The risk factors associated with PMV were evaluated using univariate and multivariable analyses.ResultsOf the 382 children enrolled, 127 (33.2%) received prolonged mechanical ventilation. The most common cause of MV in the PMV group was acute lung disease (48.0%), followed by acute circulatory system disease (26.0%), acute neurological disease (15.0%), postoperative monitoring (10.2%), and others (0.8%). Comorbidities were more prevalent among the PMV group (P = 0.004). The patients with PMV had a higher rate of premature birth (24.4 vs. 14.1%, P = 0.013) and higher PIM3 score at admission [5.6(3.0–9.9) vs. 4.1(1.7–5.5), P < 0.001]. The use of inotropes/vasopressors (63.8 vs. 43.1%, P < 0.001) was more common in patients with PMV compared with those in the non-PMV group. In the PMV group, the rate of extubation failure (39.4 vs. 6.7%, P < 0.001) was higher than the non-PMV group. The median hospital stay [35(23.0–50.0)d vs. 20(14.0–31.0)d, P < 0.001], PICU stay [22(15.0–33.0)d vs. 9(6.0–12.0)d, P < 0.001], hospitalization costs [¥391,925(263,259–614,471) vs. ¥239,497(158,723–350,620), P < 0.001], and mortality after 1-month discharge (22.0 vs. 1.6%, P < 0.001) were higher in the PMV group. Multivariate analysis revealed that age <1 year old, a higher PIM3 score at admission, prematurity, the use of inotropes or vasopressors, extubation failure, and ventilator mode on the first day of MV were associated with PMV.ConclusionsThe incidence and mortality of PMV in pediatric patients is surprisingly high. Premature infants or patients with severe disease or extubation failure are at higher risk of PMV. Patients with PMV exhibit a greater burden with regard to medical costs than those on non-PMV. It is important to establish specialized weaning units for mechanically ventilated patients with stable conditions.

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“…However, the overall value of care in SWUs and LTACHs has been questioned due to the long care time and high mortality [10,85]. Herer et al showed that SWUs may improve weaning success and shorten hospital stays but do not affect 1-year mortality when compared to weaning in acute care hospitals [86]. Unfortunately, outcomes are especially poor for those who cannot be liberated from MV in SWU and are transferred to nursing homes or subacute care units.…”

Section: Location Of Ventilator Weaningmentioning

confidence: 99%

Ventilator Weaning in Prolonged Mechanical Ventilation—A Narrative Review

Dolinay,

Hsu,

Maller

et al. 2024

JCM

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Patients requiring mechanical ventilation (MV) beyond 21 days, usually referred to as prolonged MV, represent a unique group with significant medical needs and a generally poor prognosis. Research suggests that approximately 10% of all MV patients will need prolonged ventilatory care, and that number will continue to rise. Although we have extensive knowledge of MV in the acute care setting, less is known about care in the post-ICU setting. More than 50% of patients who were deemed unweanable in the ICU will be liberated from MV in the post-acute setting. Prolonged MV also presents a challenge in care for medically complex, elderly, socioeconomically disadvantaged and marginalized individuals, usually at the end of their life. Patients and their families often rely on ventilator weaning facilities and skilled nursing homes for the continuation of care, but home ventilation is becoming more common. The focus of this review is to discuss recent advances in the weaning strategies in prolonged MV, present their outcomes and provide insight into the complexity of care.

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Outcomes of Prolonged Mechanical Ventilation Before and After Implementation of a Respiratory ICU

Cited by 4 publications

References 39 publications

Skeletal Muscle Composition Predicts Outcome in Critically Ill Patients

Skeletal Muscle Composition Predicts Outcome in Critically Ill Patients

Characteristics and Risk Factors of Children Requiring Prolonged Mechanical Ventilation vs. Non-prolonged Mechanical Ventilation in the PICU: A Prospective Single-Center Study

Ventilator Weaning in Prolonged Mechanical Ventilation—A Narrative Review

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