Post-ICU Mechanical Ventilation at 23 Long-term Care Hospitals

Scheinhorn, David J.; Hassenpflug, Meg; Votto, John; Chao, David F.; Epstein, Scott K.; Doig, Gordon S.; Knight, E. Bert; Petrak, Richard A.

doi:10.1378/chest.06-1081

Cited by 176 publications

(75 citation statements)

References 17 publications

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“…Although only 5-10% of ICU patients require prolonged mechanical ventilation, they account for .50% of the total costs [17][18][19]25]. However, more than half of the mechanically ventilated patients who were transferred to a weaning facility could finally be weaned off the ventilator [26].…”

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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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 observation is consistent with other studies that have shown mortality rates of 37% to 50% in patients who are discharged from ICUs to either nursing homes or long-term care hospitals. [21][22][23] With further study, these simple definitions may serve as adequate measures for clinical research studies in elderly populations who are using discharge disposition as a primary outcome. …”

Section: Discussionmentioning

confidence: 99%

Isolated Cervical Spine Fractures in the Elderly: A Deadly Injury

Golob

Claridge

Yowler

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…8-10 Chronically critically ill patients, such as those admitted to LTAC hospitals, often have high acuity of illness, multiple comorbidities, long hospitalizations, and frequent readmissions to acute care facilities, which increases their risk of colonization and infection with antibiotic-resistant organisms. 11,12 These characteristics are associated with poor long-term outcomes and high mortality rates. 13,14 …”

Section: Introductionmentioning

confidence: 99%

The Association Between Comorbid Illness, Colonization Status, and Acute Hospitalization in Patients Receiving Prolonged Mechanical Ventilation

et al. 2013

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BACKGROUND Long-term acute care (LTAC) hospitals provide specialized care for survivors of critical illness who require prolonged mechanical ventilation. These chronically ill patients often have multiple comorbidities and are colonized with antibiotic-resistant organisms. We investigated the association of comorbidities and colonization status with outcomes in patients requiring prolonged mechanical ventilation in an LTAC facility. We hypothesized that comorbidity burden and colonization with multiple drug resistant organisms would be associated with worse clinical outcomes. METHODS We performed a retrospective, cohort study of 157 mechanically ventilated subjects in an urban LTAC facility admitted from January 2007 to September 2009. Comorbidity burden was documented from pre-admission data using the Charlson Comorbidity Index. Colonization data were obtained from surveillance cultures. Outcomes studied included transfer back to acute care facilities, stay, and ventilator weaning status. RESULTS Within 60 days, 58.6% of subjects were transferred back to an acute care facility. The most common reason for transfer was infection/sepsis (37%). The Charlson Comorbidity Index of subjects transferred to acute care, versus those who were not, was 4.9 ± 3.1 versus 3.6 ± 2.7 (P = .01), an odds ratio of 1.1 for each 1-point increase in Charlson Comorbidity Index (95% CI 1.03–1.71, P = .02). Colonization with acinetobacter was associated with higher incidence of transfer (71% vs 51%, P = .01). The odds ratio for transfer to acute care was 1.3 for each additional organism colonizing a subject (95% CI 1.11–1.53, P = .006). CONCLUSIONS Higher comorbidity burden and colonization status were associated with increased risk of transfer to acute care. Further investigation is needed to clarify this relationship between comorbidity burden and colonization with change in clinical status.

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Post-ICU Mechanical Ventilation at 23 Long-term Care Hospitals

Cited by 176 publications

References 17 publications

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

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

Isolated Cervical Spine Fractures in the Elderly: A Deadly Injury

The Association Between Comorbid Illness, Colonization Status, and Acute Hospitalization in Patients Receiving Prolonged Mechanical Ventilation

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