Risk Assessment for Inpatient Survival in the Long-term Acute Care Setting After Prolonged Critical Illness

D'Amico, Jane E Dematte; Donnelly, Helen K.; Mutlu, Go ̈khan M.; Feinglass, Joseph; Jovanovic, Borko; Ndukwu, I. M.

doi:10.1378/chest.124.3.1039

Cited by 36 publications

(12 citation statements)

References 38 publications

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“…Two prognostic models have been published for PMV patients managed in long-term acute care hospitals,(15, 16) but neither have been validated, and only one included long-term follow-up. In one study, existing illness severity scores demonstrated poor discrimination and calibration for hospital mortality in PMV patients at an LTCH.…”

Section: Discussionmentioning

confidence: 99%

A prognostic model for one-year mortality in patients requiring prolonged mechanical ventilation*

Carson

Garrett

Hanson

et al. 2008

Critical Care Medicine

118

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Objective-A measure that identifies patients who are at high risk of mortality after prolonged ventilation will help physicians communicate prognosis to patients or surrogate decision-makers. Our objective was to develop and validate a prognostic model for 1-year mortality in patients ventilated for 21 days or more.Design-Prospective cohort study. Setting-University-based tertiary care hospitalPatients-300 consecutive medical, surgical, and trauma patients requiring mechanical ventilation for at least 21 days were prospectively enrolled. Measurements and MainResults-Predictive variables were measured on day 21 of ventilation for the first 200 patients and entered into logistic regression models with 1-year and 3-month mortality as outcomes. Final models were validated using data from 100 subsequent patients. One-year mortality was 51% in the development set and 58% in the validation set. Independent predictors of mortality included requirement for vasopressors, hemodialysis, platelet count ≤150 ×10 9 /L, and age ≥50. Areas under the ROC curve for the development model and validation model were 0.82 (se 0.03) and 0.82 (se 0.05) respectively. The model had sensitivity of 0.42 (se 0.12) and specificity of 0.99 (se 0.01) for identifying patients who had ≥90% risk of death at 1 year. Observed mortality was highly consistent with both 3-and 12-month predicted mortality. These four predictive variables can be used in a simple prognostic score that clearly identifies low risk patients (no risk factors, 15% mortality) and high risk patients (3 or 4 risk factors, 97% mortality).Conclusions-Simple clinical variables measured on day 21 of mechanical ventilation can identify patients at highest and lowest risk of death from prolonged ventilation.

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Section: Discussionmentioning

confidence: 99%

A prognostic model for one-year mortality in patients requiring prolonged mechanical ventilation*

Carson

Garrett

Hanson

et al. 2008

Critical Care Medicine

118

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“…Several studies reported that these patients consumed a disproportionately high amount of healthcare resources and medical expenses both in the intensive care unit (ICU) and after hospital discharge1-10. There were also several reports regarding prognostic factors for these patients to help physicians determine prognoses by communicating with patients or their surrogates3,11,12.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors of Patients Requiring Prolonged Mechanical Ventilation in a Medical Intensive Care Unit of Korea

et al. 2012

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BackgroundWe evaluated the clinical outcomes and prognostic factors of patients requiring prolonged mechanical ventilation (PMV), defined as ventilator care for ≥21 days, who were admitted to the medical intensive care unit (ICU) of a university hospital in Korea.MethodsDuring the study period, a total of 2,644 patients were admitted to the medical ICU, and 136 patients (5.1%) were enrolled between 2005 and 2010.ResultsThe mean age of the patients was 61.3±14.5 years, and 94 (69.1%) were male. The ICU and six-month cumulative mortality rates were 45.6 and 58.8%, respectively. There were 96 patients with tracheostomy placement after admission and their mean period from admission to the day of tracheostomy was 21.3±8.4 days. Sixty-three patients (46.3%) were successfully weaned from ventilator care. Of the ICU survivors (n=74), 34 patients (45.9%) were transferred to other hospitals (not university hospitals). Two variables (thrombocytopenia [hazard ratio (HR), 1.964; 95% confidence interval (CI), 1.225~3.148; p=0.005] and the requirement for vasopressors [HR, 1.822; 95% CI, 1.111~2.986; p=0.017] on day 21) were found to be independent factors of survival on based on the Cox proportional hazard model.ConclusionWe found that patients requiring PMV had high six-month cumulative mortality rates, and that two clinical variables (measured on day 21), thrombocytopenia and requirement for vasopressors, may be associated with prognostic indicators.

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“…In prolonged MV patients, successful weaning does not ensure long-term survival; chronically critically ill patients have underlying comorbid conditions, residual organ dysfunction and intercurrent complications that increase the risk of death [27]. In fact, for prolonged MV, advanced age, poor previous functional status and residual organ failures have been reported to be associated with greater mortality [28, 29]. In the present study, 1-year mortality was found to in the lower range of those reported previously [18].…”

Section: Discussionmentioning

confidence: 99%

Noninvasive ventilation during the weaning process in chronically critically ill patients

et al. 2016

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Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV) during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process.We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h.231 chronically critically ill patients were included in the study. 198 (85.71%) patients achieved weaning success (mean weaning time 25.45±16.71 days), of whom 40 (21.4%) needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01–1.15), p=0.013), with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97).NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning.

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Risk Assessment for Inpatient Survival in the Long-term Acute Care Setting After Prolonged Critical Illness

Cited by 36 publications

References 38 publications

A prognostic model for one-year mortality in patients requiring prolonged mechanical ventilation*

A prognostic model for one-year mortality in patients requiring prolonged mechanical ventilation*

Prognostic Factors of Patients Requiring Prolonged Mechanical Ventilation in a Medical Intensive Care Unit of Korea

Noninvasive ventilation during the weaning process in chronically critically ill patients

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