Survey of Prolonged Mechanical Ventilation in Intensive Care Units in Mainland China

Abstract

INTRODUCTION:In mainland China, there are no special care centers (long-term acute care, weaning, chronic care facilities) for patients requiring prolonged mechanical ventilation (PMV). Our goal was to characterize the prevalence and outcome of patients undergoing PMV in Chinese intensive care units (ICUs). METHODS: A prospective 1-d prevalence study was performed at 55 ICUs, with 28-d follow-up. RESULTS: On the observation day, 622 adult patients occupied ICU beds. Enrollment criteria were met by 302 subjects receiving invasive mechanical ventilation, of which 109 (36.1%) had received ventilation for more than 21 d (median 51, 21-3,419), which was defined as PMV. During the following 28 d, another 45 subjects were classified as receiving PMV, but only 5% (3/58) of the subjects who were newly admitted to the ICU on the study day received PMV. Thirty-six (22.9%) of the 157 subjects receiving PMV were weaned, and 81 (51.6%) continued ventilation in the ICU. In the logistic regression analysis, age >74 y (odds ratio ‫؍‬ 2.78, 95% CI 1.05-7.40, P ‫؍‬ .041) and chronic congestive heart failure (odds ratio ‫,32.21؍‬ 95% CI 1.48 -101.05, P ‫؍‬ .020) were associated with failure to wean in 28 d, while acute respiratory distress syndrome (ARDS) as the reason for mechanical ventilation (odds ratio ‫؍‬ 0.14, 95% CI 0.04 -0.52, P ‫؍‬ .003) was associated with successful weaning. CONCLUSION: The number of subjects receiving PMV was surprisingly high in this cross-section of Chinese ICUs. In the following 28 ICU days, only a small proportion of these subjects were weaned. Age and chronic heart dysfunction were high risk factors for weaning failure.

Clinical features and outcomes of prolonged mechanical ventilation: a single-center retrospective observational study

“…In addition, previous studies have shown that PMV patients had a longer duration of MV, ICU stay, and hospital stay compared with those who did not. According to these studies, duration of MV among PMV patients was 29-51 days, ICU stay was 33-52 days, and hospital stay was 51-77 days [2,4,[12][13][14]20]. These studies were conducted in countries lacking the concept of weaning centers, and the results were consistent with those observed in our study.…”

“…Conversely, in countries such as Japan lacking weaning centers, patients who require PMV may occupy ICU beds in acute care hospitals for an extended period, thereby affecting the fair allocation of critical care resources [2,4,[12][13][14]. Furthermore, these patients place substantial loads on intensivists throughout the long period of the weaning trial.…”

Hypercapnic Ventilatory Response in the Weaning of Patients with Prolonged Mechanical Ventilation

“…The subjects in our weaning-failure group were older than those in the weaning-success group (82.5 years ± 10.3 years versus 70.6 years ± 15.3 years, P = .034). Some studies [ 30 , 31 ] have reported that advanced age is a risk factor for weaning failure. Comorbidities are common in the elderly and a lower comorbidity burden is more likely to result in successful weaning from mechanical ventilation [ 30 ].…”

The patient needing prolonged mechanical ventilation: a narrative review

“…It is interesting to evaluate what happens to these patients needing PMV where there is no LWU. A prospective prevalence study [ 70 ] in 55 chinese ICUs, with 28 days follow up, reported that 36.1% of patients had received MV for more than 21 days, 23% of them being weaned. Despite the public health burden required by patients requiring PMV, a systematic review [ 71 ] reports that only 14 articles in the biomedical literature have tested patient-level factors associated with long-term mortality.…”