Ventilator-Dependent Survivors of Catastrophic Illness Transferred to 23 Long-term Care Hospitals for Weaning From Prolonged Mechanical Ventilation

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.06-1079

Cited by 121 publications

(128 citation statements)

References 24 publications

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“…However, the rate of weaning success in patients requiring PMV is low, ranging from 38% to 78% (11,(16)(17)(18). Several studies showed that the incidence of chronic obstructive pulmonary disease (COPD), neuromuscular disease, high body mass index, pneumonia, and high positive end-expiratory pressure were associated with weaning failure in patients requiring PMV (3,19).…”

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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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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“…Patients in LTCHs are generally defined as chronic critical patients (2,4). This term was first used in 1985 by Girard and Raffin (11).…”

Section: General Features Of Ltchmentioning

confidence: 99%

“…LTCHs provide prolonged complex care and wound care in the period following the acute stage of disease (2,3).…”

Section: Introductionmentioning

confidence: 99%

“…These patients have usually been discharged from the ICU but still require more care from a care organization, which can be taken in an inpatient rehabilitation centre or at home (1, 4,6). Chronic critical patients are an important component of the daily work of every ICU clinician (2). Although chronic critical patients comprise only 10% of admittances to the ICU in the USA, they use 40% of the IC resources (2,7).…”

Section: Introductionmentioning

confidence: 99%

“…Chronic critical patients are an important component of the daily work of every ICU clinician (2). Although chronic critical patients comprise only 10% of admittances to the ICU in the USA, they use 40% of the IC resources (2,7). Patients with chronic critical illness those who exhibit complex condition that often result in ongoing respiratory failure (8).…”

Section: Introductionmentioning

confidence: 99%

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Long-term care hospitals in Turkey: a review

Dinçer

Kahveci

Döğer³

et al. 2017

East Mediterr Health J

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Centres de long séjour hospitaliers en Turquie : analyseUn centre hospitalier de soins de longue durée (CHSLD) est un établissement spécialisé accueillant des patients qui souffrent de graves problèmes de santé et nécessitent des soins continus et intensifs sans avoir à recourir à des méthodes diagnostiques complètes. Les CHLSD fournissent des soins prolongés et complexes ainsi que des soins de plaies dans la période qui suit la phase aigüe de la maladie. Aux États-Unis, lorsque le séjour en unité des soins intensifs est prolongé, les patients peuvent être transférés vers un CHSLD. Medicare recommande une période d'hospitalisation en CHSLD de plus de 25 jours. Le système des CHSLD en Europe est différent de celui qui est établi dans d'autres pays non-européens. On note par ailleurs des différences entre les pays européens eux-mêmes. Dans la pratique, les patients qui ont besoin de soins de longue durée en Turquie sont hospitalisés en unités de soins intensifs. Le concept des soins de longue durée est nouveau dans le système de santé turc et il n'y existe pas d'études sur les CHSLD. Une proportion importante des lits réservés aux unités de soins intensifs en Turquie sont utilisés pour les soins de longue durée aux patients atteints de problèmes complexes. ABSTRACT A long-term care hospital (LTCH) is a specialized facility for patients with serious health problems who require continuous and intensive care but not comprehensive diagnostic methods. LTCHs provide prolonged complex care and wound care in the period following the acute stage of disease. When intensive care unit (ICU) stay is prolonged in the United States of America, the patients may be transferred to an LTCH. Medicare suggests hospitalization > 25 days in LTCHs. The LTC system in Europe differs from that in other non-European countries and differences are also seen among European countries. In practice, patients who need LTC in Turkey are hospitalized in ICUs. Long term care is a new concept for the Turkish health system and there are no studies on LTCHs in Turkey. A significant proportion of intensive care beds in Turkey are used for long-term hospitalized patients with complex problems. This is a clear waste of resources. The establishment of LTCHs in Turkey would prevent from this waste and provide the opportunity to increase experience of complex treatments.

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Communication About Chronic Critical Illness

Nelson

Mercado²,

Camhi³

et al. 2007

Arch Intern Med

146

115

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Background: Despite poor outcomes, life-sustaining treatments including mechanical ventilation are continued for a large and growing population of patients with chronic critical illness. This may be owing in part to a lack of understanding resulting from inadequate communication between clinicians and patients and families. Our objective was to investigate the informational needs of patients with chronic critical illness and their families and the extent to which these needs are met. Methods: In this prospective observational study conducted at 5 adult intensive care units in a large, universityaffiliated hospital in New York, New York, 100 patients with chronic critical illness (within 3-7 days of elective tracheotomy for prolonged mechanical ventilation) or surrogates for incapacitated patients were surveyed using an 18-item questionnaire addressing communication about chronic critical illness. Main outcome measures included ratings of importance and reports of whether information was received about questionnaire items. Results: Among 125 consecutive, eligible patients, 100 (80%) were enrolled; questionnaire respondents included 2 patients and 98 surrogates. For all items, more than 78% of respondents rated the information as important for decision making (Ͼ98% for 16 of 18 items). Respondents reported receiving no information for a mean (SD) of 9.0 (3.3) of 18 items, with 95% of respondents reporting not receiving information for approximately one-quarter of the items. Of the subjects rating the item as important, 77 of 96 (80%) and 69 of 74 (93%) reported receiving no information about expected functional status at hospital discharge and prognosis for 1-year survival, respectively. Conclusions: Many patients and their families may lack important information for decision making about continuation of treatment in the chronic phase of critical illness. Strategies for effective communication in this clinical context should be investigated and implemented.

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Ventilator-Dependent Survivors of Catastrophic Illness Transferred to 23 Long-term Care Hospitals for Weaning From Prolonged Mechanical Ventilation

Cited by 121 publications

References 24 publications

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

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

Long-term care hospitals in Turkey: a review

Communication About Chronic Critical Illness

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