Ventilator-Dependent Survivors of Catastrophic Illness: A Multicenter Outcomes Study

Shock on Admission Day Is the Best Predictor of Prolonged Mechanical Ventilation in the ICU

“…27 The severe physiologic derangement of our patients might be reflected by outcomes other than mortality (observed and predicted mortalities are similar), such as the high incidence of PMV. Notwithstanding this, 73% of patients with PMV survived to leave the hospital, as reported in other single-center or multicenter studies 24,30 conducted in either acute-care or long-term acute-care facilities. The high survival rate of PMV patients be due to the physiologic selection process that they have already undergone, 26 given that many severely ill patients die during the first days of ICU stay, as shown by our 130 early death patients.…”

Management of Patients Requiring Prolonged Mechanical Ventilation

“…A preliminary report 6 from a multicenter observational study in 23 LTAC hospitals encompassing Ͼ 1,400 PMV patients found an average age of 72 years and a median APACHE III acute physiologic score of 36 on admission. These patients often had coexistent nonpulmonary diseases that are associated with poor outcome.…”

“…In surveying the existing literature, PMV has been variously defined as Ͼ 24 h, 1,2 Ͼ 2 days, 3 Ͼ 14 days, 4 or Ͼ 29 days 5 of mechanical ventilation or, alternatively, the need for post-ICUs mechanical ventilatory support. 6 The most widely applied definitions involve patients who fall under several of the Center for Medicare and Medicaid Services (CMS) Diagnosis Related Groups (DRGs) focused on mechanical ventilatory support (DRG 475, respiratory disease and mechanical ventilation Ͼ 96 h; DRG 483, tracheostomy with mechanical ventilation Ն 96 h with principal diagnosis except for face, head, and neck diagnoses; DRG 541, tracheostomy with mechanical ventilation Ն 96 h with principal diagnosis except face, mouth, and neck diagnosis with major operating room procedure; DRG 542, tracheostomy with mechanical ventilation Ն 96 h with principal diagnosis except face, mouth, and neck diagnosis without major operating room procedure. Generally, these patients who have required at least 6 h of mechanical ventilation for Ͼ 21 consecutive days.…”

“…Defining a time threshold for considering the tracheotomized patient with PMV successfully liberated from mechanical ventilation is thus less intuitive. Proposed definitions of weaning success in this setting include the acute ICU threshold of 48 h, 7 days, or 14 days without ventilatory support, freedom from ventilatory support at the time of hospital discharge, 4,6,8,21 or at 6 months to 1 year after the onset of mechanical ventilation. Any definition of weaning success may be confounded by differences in patient population, discharge criteria, and institution specific characteristics (eg, transfers within the host hospital system).…”

Weaning vom Respirator beginnt mit der Intubation

“…In einer multizentrischen Feldstudie mit >1400 Patienten, die sich infolge LZB in Weaningzentren befanden, wiesen 54% der Patienten eine signifikante kardiale Begleiterkrankung auf [32] …”