Outcome of patients undergoing prolonged mechanical ventilation after critical illness*

Bigatello, Luca M.; Stelfox, Henry T.; Berra, Lorenzo; Schmidt, Ulrich; Gettings, Elise

doi:10.1097/01.ccm.0000287589.16724.b2

Cited by 93 publications

(80 citation statements)

References 28 publications

(47 reference statements)

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“…Indeed, it is our policy to treat all patients with a COPD exacerbation with respiratory failure and a pH Ͼ 7.25 in the respiratory ward. 30 Only a small proportion of our patients were discharged to home from the RICU, in line with data reported by Bigatello et al, 19 who reported that only 2% of their patients were discharged to home.…”

Section: Discussionsupporting

confidence: 78%

“…16,17 Data collected on more than 3,000 patients admitted to 5 Italian RICUs, mainly dedicated to weaning from mechanical ventilation, showed a mortality rate of about 15%, 18 which is in line with our results. Concerning a RICU located inside an acute care hospital, Bigatello et al 19 suggested that a considerable number of patients were ready to come off mechanical ventilation at the time of RICU admission, implying that in the preceding ICU stay, discontinuing mechanical ventilation had not always been a priority, and explaining the quite low mortality rate even 1 year after hospital admission.…”

Section: Discussionmentioning

confidence: 99%

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Influence of the Admission Pattern on the Outcome of Patients Admitted to a Respiratory Intensive Care Unit: Does a Step-Down Admission Differ From a Step-Up One?

Valentini¹,

Pacilli²,

Carbonara³

et al. 2013

Respir Care

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BACKGROUND:The outcomes of patients admitted to a respiratory ICU (RICU) have been evaluated in the past, but no study has considered the influence of location prior to RICU admission. METHODS: We analyzed prospectively collected data from 326 consecutive patients admitted to a 7-bed RICU. The primary end points were survival and severity of morbidity-related complications, evaluated according to the patient's location prior to RICU admission. Three admission pathways were considered: step-down for patients transferred from the ICUs of our hospital; step-up for patients coming from our respiratory wards or other medical wards; and directly for patients coming from the emergency department. The secondary end point was the potential influence of several risk factors for morbidity and mortality. RESULTS: Of the 326 subjects, 92 (28%) died. Overall, subjects admitted in a step-up process had a significantly higher mortality (P < .001) than subjects in the other groups. The mortality rate was 64% for subjects admitted from respiratory ward, 43% for those from medical wards, and 18% for subjects from both ICU and emergency department (respiratory ward vs medical ward P ‫؍‬ .04, respiratory ward vs emergency department P < .001, respiratory ward vs ICU P < .001, medical ward vs emergency department P < .001, and medical ward vs ICU P < .001). Subjects admitted from a respiratory ward had a lower albumin level, and Simplified Acute Physiology Score II was significantly higher in subjects following a step-up admission. About 30% of the subjects admitted from a respiratory ward received noninvasive ventilation as a "ceiling treatment." The highest odds ratios related to survival were subject location prior to RICU admission and female sex. Lack of use of noninvasive ventilation, younger age, female sex, higher albumin level, lower Simplified Acute Physiology Score II, higher Barthel score, and absence of chronic heart failure were also statistically associated with a lower risk of death. CONCLUSIONS: The pathway of admission to a RICU is a determinant of outcome. Patients following a step-up pattern are more likely to die. Other major determinants of survival are age, nutritional status and female sex.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Influence of the Admission Pattern on the Outcome of Patients Admitted to a Respiratory Intensive Care Unit: Does a Step-Down Admission Differ From a Step-Up One?

Valentini¹,

Pacilli²,

Carbonara³

et al. 2013

Respir Care

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“…The number of the ventilator-free days in a period of 28 days was defined by the sum of days that patients spent without an invasive airway or a noninvasive interface up to day 28 after ICU admission. Patients who had an invasive airway for o21 consecutive days where considered to have prolonged mechanical ventilation [9]. Patients were considered to have prolonged weaning when they were breathing through an invasive or noninvasive airway with ventilator assistance (pressure support ventilation, proportional assist ventilation or continuous positive airway pressure) for o7 consecutive days [10].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and prognosis of COPD in critically ill patients between 1998 and 2008

et al. 2012

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The epidemiology of chronic obstructive pulmonary disease (COPD) in critically ill patients is largely unknown. The aims of the study were: 1) to determine whether COPD, either as the cause of intensive care unit (ICU) admission or as a comorbid condition, is an independent risk factor for increased morbidity and mortality; and 2) to investigate time trends in proportion and outcome of acute respiratory failure in patients with COPD admitted to ICUs.Prospectively recorded data from 194 453 adults consecutively admitted to 87 Austrian ICUs over a period of 11 years (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) were retrospectively analysed.COPD was present in 8.6% of all patients. The risk-adjusted mortality of patients with COPD was higher than in patients without COPD. The presence of COPD was an independent risk factor for increased mortality and was associated with prolonged mechanical ventilation and prolonged weaning. During the course of the 11 years, the proportion of acute respiratory failure due to COPD increased by about two-thirds, and the use of noninvasive ventilation within the COPD cohort more than doubled. Simultaneously, the risk-adjusted mortality of patients with COPD improved.In critically ill patients, the presence of COPD is increasing and is an independent risk factor for mortality and morbidity.

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“…Weaning success is an important prognostic factor in patients requiring PMV (14,15). However, the rate of weaning success in patients requiring PMV is low, ranging from 38% to 78% (11,(16)(17)(18).…”

Section: Of MV In Differentmentioning

confidence: 99%

Clinical factors associated with weaning failure in patients requiring prolonged mechanical ventilation

Shin¹,

Chang²,

Ahn³

et al. 2017

J. Thorac. Dis.

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Background: For patients requiring prolonged mechanical ventilation (PMV), weaning is difficult and mortality is very high. PMV has been defined recently, by consensus, as constituting ≥21 consecutive days of mechanical ventilation (MV) for ≥6 hours per day. This study aimed to evaluate the clinical factors predicting weaning failure in patients undergoing PMV in medical intensive care unit (ICU). Results: Among the 127 patients requiring PMV, 41 (32.3%) were successfully weaned from MV. The median age of the weaning failure group was higher than that of the weaning success group (74.0 vs. 70.0 years; P=0.003). The proportion of male patients was 58.5% in the weaning success group and 72.1% in the weaning failure group, respectively. The most common reasons for ICU admission were respiratory causes (66.1%) followed by cardiovascular causes (16.5%) in both groups. ICU mortality and in-hospital mortality rates were 55.1% and 55.9%, respectively. In the multivariate analysis, respiratory causes of ICU admission [odds ratio (OR), 3.98; 95% confidence interval (CI), 1.29-12.30; P=0.016] and a high sequential organ failure assessment (SOFA) score on day 21 of MV (OR, 1.47; 95% CI, P=0.001) were significantly associated with weaning failure in patients requiring PMV. The area under the receiver operating characteristic (ROC) curve of the SOFA score on day 21 of MV for predicting weaning failure was 0.77 (95% CI, 0.67-0.87; P=0.000).Conclusions: Respiratory causes of ICU admission and a high SOFA score on day 21 of MV could be predictive of weaning failure in patients requiring PMV.

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Outcome of patients undergoing prolonged mechanical ventilation after critical illness*

Cited by 93 publications

References 28 publications

Influence of the Admission Pattern on the Outcome of Patients Admitted to a Respiratory Intensive Care Unit: Does a Step-Down Admission Differ From a Step-Up One?

Influence of the Admission Pattern on the Outcome of Patients Admitted to a Respiratory Intensive Care Unit: Does a Step-Down Admission Differ From a Step-Up One?

Prevalence and prognosis of COPD in critically ill patients between 1998 and 2008

Clinical factors associated with weaning failure in patients requiring prolonged mechanical ventilation

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