Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study Public Deposited

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Creator
  • Olsen, Maren K
    • Other Affiliation: Center for Health Services Research in Primary Care, VA Medical Center, 11033 Hock Bldg 2424 Erwin Road, Durham, North Carolina, 27705 USA; Department of Biostatistics and Bioinformatics, Duke University, 7020 N. Pavilion Building, Durham, North Carolina, 27710 USA
  • Cox, Christopher E
    • Other Affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University, Box 3683, Durham, North Carolina, 27710 USA
  • Chelluri, Lakshmipathi
    • Other Affiliation: Department of Critical Care Medicine, University of Pittsburgh School of Medicine 637 Scaife, Pittsburgh, Philadelphia, 15261 USA
  • Lindquist, Jennifer H
    • Other Affiliation: Center for Health Services Research in Primary Care, VA Medical Center, 11033 Hock Bldg 2424 Erwin Road, Durham, North Carolina, 27705 USA
  • Govert, Joseph A
    • Other Affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University, Box 3683, Durham, North Carolina, 27710 USA
  • Carson, Shannon
    • Affiliation: School of Medicine, Department of Medicine, Division of Pulmonary Diseases and Critical Care Medicine
Abstract
  • Abstract Introduction The outcomes of patients ventilated for longer than average are unclear, in part because of the lack of an accepted definition of prolonged mechanical ventilation (PMV). To better understand the implications of PMV provision, we compared one-year health outcomes between two common definitions of PMV as well as between PMV patients and those ventilated for shorter periods of time. Methods We conducted a secondary analysis of prospectively collected data from medical and surgical intensive care units at an academic tertiary care medical center. The study included 817 critically ill patients ventilated for ≥ 48 hours, 267 (33%) of whom received PMV based on receipt of a tracheostomy and ventilation for ≥ 96 hours. A total of 114 (14%) patients met the alternate definition of PMV by being ventilated for ≥ 21 days. Survival, functional status, and costs were measured at baseline and at 2, 6, and 12 months after discharge. Of one-year survivors, 71 (17%) were lost to follow up. Results PMV patients ventilated for ≥ 21 days had greater costs ($140,409 versus $143,389) and higher one-year mortality (58% versus 48%) than did PMV patients with tracheostomies who were ventilated for ≥ 96 hours. The majority of PMV deaths (58%) occurred after hospital discharge whereas 67% of PMV patients aged 65 years or older had died by one year. At one year PMV patients on average had limitations in two basic and five instrumental elements of functional status that exceeded both their pre-admission status and the one-year disability of those ventilated for < 96 hours. Costs per one-year survivor were $423,596, $266,105, and $165,075 for patients ventilated ≥ 21 days, ≥ 96 hours with a tracheostomy, and < 96 hours, respectively. Conclusion Contrasting definitions of PMV capture significantly different patient populations, with ≥ 21 days of ventilation specifying the most resource-intensive recipients of critical care. PMV patients, particularly the elderly, suffer from a significant burden of costly, chronic critical illness and are at high risk for death throughout the first year after intensive care.
Date of publication
Identifier
  • doi:10.1186/cc5667
  • 17244364
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Christopher E Cox et al.; licensee BioMed Central Ltd.
License
Journal title
  • Critical Care
Journal volume
  • 11
Journal issue
  • 1
Page start
  • R9
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1364-8535
Bibliographic citation
  • Critical Care. 2007 Jan 23;11(1):R9
Access
  • Open Access
Publisher
  • BioMed Central Ltd
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