Outcomes and prognostic factors in patients with prolonged acute mechanical ventilation: A single-center study in Korea

Lee, Sangeun; Kim, Min Ji; Jeong, Eun Suk; Jo, Eun-Jung; Eom, Jung Seop; Mok, Jeongha; Kim, Mi‐Hyun; Kim, Ki Uk; Park, Hye Kyung; Lee, Min Ki; Lee, Kwangha

doi:10.1016/j.jcrc.2015.05.020

Cited by 7 publications

(9 citation statements)

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“…Accordingly, a prediction model that identifies patients with poor or good risks for clinical course may be useful for informing the discussions among the clinicians and the patients' families (or surrogates). Although there were reported data about the prognostic factors for these patients 25 , developing a new mortality model through a large-scale multicenter study would be necessary for the South Korean patient population requiring PAMV.…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Value of the Charlson's Comorbidity Index in Patients with Prolonged Acute Mechanical Ventilation: A Single Center Experience

Song

Lee

et al. 2016

Tuberc Respir Dis

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BackgroundThe aim of our study was to evaluate the prognostic value of Charlson's weighted index of comorbidities (WIC) in patients with prolonged acute mechanical ventilation (PAMV, ventilator care ≥96 hours).MethodsWe retrospectively enrolled 299 Korean PAMV patients who were admitted in a medical intensive care unit (ICU) of a university-affiliated tertiary care hospital between 2008 and 2013. Survivors were defined as patients who survived for 60 days after ICU admission.ResultsThe patients' mean age was 65.1±14.1 years and 70.6% were male. The mean ICU and hospital length of stay was 21.9±19.7 and 39.4±39.1 days, respectively. In addition, the 60-day mortality rate after ICU admission was 35.5%. The mean WIC was 2.3±1.8, with significant differences between nonsurvivors and survivors (2.7±2.1 vs. 2.1±1.7, p<0.05). The area under the curve of receiver-operating-characteristics curve for WIC was 0.593 (95% confidence interval [CI], 0.523–0.661; p<0.05). Based on Kaplan-Meier curves of 60-day survival, WIC ≥5 had statistically lower survival than WIC <5 (log-rank test, p<0.05). In a multivariate Cox proportional hazard model, WIC ≥5 was associated with poor prognosis (hazard ratio, 1.901; 95% CI, 1.140–3.171; p<0.05). The mortality rate of patients with WIC ≥5 was 54.2%.ConclusionOur study showed a WIC score ≥5 might be helpful in predicting 60-day mortality in PAMV patients.

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Section: Discussionmentioning

confidence: 99%

The Prognostic Value of the Charlson's Comorbidity Index in Patients with Prolonged Acute Mechanical Ventilation: A Single Center Experience

Song

Lee

et al. 2016

Tuberc Respir Dis

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“…The prognosis of patients receiving MV is influenced by many factors, including age, Acute Physiology And Chronic Health Evaluation (APACHE) II score (or other measure of functional status), severe sepsis, acute lung injury (ALI), acute respiratory distress syndrome (ARDS), acute renal, cardiovascular or hepatic failure, and requirement for neuromuscular blockers or vasopressors. [1,2,5,13] A multicenter study in China reported that age, APACHE II score, a partial pressure of arterial oxygen to fraction of inspired oxygen (PaO 2 /FiO 2 ) ratio <200, and chronic pulmonary diseases were independently associated with ICU mortality. [12] Another study in Mainland China found that APACHE II score, severe sepsis, ALI, or ARDS and acute kidney injury (AKI) were independent risk factors for in-hospital mortality in critically ill patients in the ICU, 75% of who received MV.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit

Liang¹,

Li²,

Dong³

et al. 2019

Medicine

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Data on outcomes of patients receiving mechanical ventilation (MV) in China are scarce.To investigate factors associated with the prognosis of patients given MV in the intensive care unit (ICU).A 12-year (January 1, 2006–December 31, 2017) retrospective cohort study.ICU of Beijing Geriatric Hospital, China.A total of 905 patients aged ≥16 years given MV during the study period.None.Among 905 patients included (610 men; median age, 78 years; Acute Physiology and Chronic Health Evaluation [APACHE]-II score, 27.3 ± 8.9), 585 survived (388 men; median age, 77 years; average APACHE-II score, 25.6 ± 8.4), and 320 died in the ICU (222 men; median age, 78 years; APACHE-II score, 30.6 ± 8.9). All-cause ICU mortality was 35.4%. In patients aged <65 years, factors associated with ICU mortality were APACHE-II score (odds ratio [OR], 1.108; 95% confidence interval [95% CI], 1.021–1.202; P = .014), nosocomial infection (OR, 6.618; 95% CI, 1.065–41.113; P = .043), acute kidney injury (OR, 17.302; 95% CI, 2.728–109.735; P = .002), invasive hemodynamic monitoring (OR, 10.051; 95% CI, 1.362–74.191; P = .024), MV for cardiopulmonary resuscitation (OR, 0.122; 95% CI, 0.016–0.924; P = .042), duration of MV (OR, 0.993; 95% CI, 0.988–0.998; P = .008), successful weaning from MV (OR, 0.012; 95% CI, 0.002–0.066; P < .001), and renal replacement therapy (OR, 0.039; 95% CI, 0.005–0.324; P = .003). In patients aged ≥65 years, factors associated with mortality were APACHE-II score (OR, 1.062; 95% CI, 1.030–1.096; P < .001), nosocomial infection (OR, 2.427; 95% CI, 1.359–4.334; P = .003), septic shock (OR, 2.017; 95% CI, 1.153–3.529; P = .014), blood transfusion (OR, 1.939; 95% CI, 1.174–3.202; P = .010), duration of MV (OR, 0.999; 95% CI, 0.999–1.000; P = .043), and successful weaning from MV (OR, 0.027; 95% CI, 0.015–0.047; P < .001).APACHE-II score, successful weaning, and nosocomial infection in the ICU are independently associated with the prognosis of patients given MV in the ICU.

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“…Studies have reported that some clinical variables are prognostic factors in patients under ventilator care [6,[19][20][21][22]. Therefore, the following laboratory and clinical data obtained on day 4 of MV were recorded: complete blood count, the lowest PaO2/FiO2 ratio, the need of vasopressors and hemodialysis, and unavoidable requirement of neuromuscular blocking agents (NMBAs) due to ventilator dyssynchrony (intermittent or continuous).…”

Section: Data Collectionmentioning

confidence: 99%

“…Based on a report about factors that are prognostic for 28-day mortality [6], we hypothesized that some clinical variables on day 4 of MV may be useful for predicting the long-term prognosis of PAMV patients. Previous studies have suggested that demographic characteristics, body mass index (BMI), and comorbidities have prognostic value in patients with critical illness [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Development of a prognostic scoring system in patients with pneumonia requiring ventilator care for more than 4 days: a single-center observational study

Kang

Lee

2021

Acute Crit Care

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Background: The aim of the present study was to develop a prognostic model using demographic characteristics, comorbidities, and clinical variables measured on day 4 of mechanical ventilation (MV) for patients with prolonged acute mechanical ventilation (PAMV; MV for >96 hours). Methods: Data from 437 patients (70.9% male; median age, 68 years) were obtained over a period of 9 years. All patients were diagnosed with pneumonia. Binary logistic regression identified factors predicting mortality at 90 days after the start of MV. A PAMV prognosis score was calculating ß-coefficient values and assigning points to variables. Results: The overall 90-day mortality rate was 47.1%. Five factors (age ≥65 years, body mass index <18.5 kg/m 2 , hemato-oncologic diseases as comorbidities, requirement for vasopressors on day 4 of MV and requirement for neuromuscular blocking agents on day 4 of MV) were identified as prognostic indicators. Each factor was valued as +1 point, and used to develop a PAMV prognosis score. This score showed acceptable discrimination (area under the receiver operating characteristic curve of 0.695 for mortality, 95% confidence interval 0.650-0.738, p<0.001), and calibration (Hosmer-Lemeshow chi-square=6.331, with df 7 and p=0.502). The cutoff value for predicting mortality based on the maximum Youden index was ≤2 (sensitivity, 87.5%; specificity, 41.3%). For patients with PAMV scores ≤1, 2, 3 and ≥4, the 90-day mortality rates were 29.2%, 45.7%, 67.9%, and 90.9%, respectively (P<0.001). Conclusions: Our study developed a PAMV prognosis score for predicting 90-day mortality. Further research is needed to validate the utility of this score.

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Outcomes and prognostic factors in patients with prolonged acute mechanical ventilation: A single-center study in Korea

Cited by 7 publications

References 24 publications

The Prognostic Value of the Charlson's Comorbidity Index in Patients with Prolonged Acute Mechanical Ventilation: A Single Center Experience

The Prognostic Value of the Charlson's Comorbidity Index in Patients with Prolonged Acute Mechanical Ventilation: A Single Center Experience

Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit

Development of a prognostic scoring system in patients with pneumonia requiring ventilator care for more than 4 days: a single-center observational study

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