Outcomes of long-term ventilator patients: a descriptive study

1997 ◽  
Vol 6 (2) ◽  
pp. 99-105 ◽  
Author(s):  
SL Douglas ◽  
BJ Daly ◽  
PF Brennan ◽  
S Harris ◽  
M Nochomovitz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Care Facility ◽  
Systematic Research ◽  
Icu Patients ◽  
Sociodemographic Data ◽  
Extended Care ◽  
Long Term Ventilation ◽  
Prospective Longitudinal

BACKGROUND: Long-term ICU patients who require prolonged mechanical ventilation are a growing segment of the in-hospital population. Despite recognition that this population is costly to care for no systematic research has been done on the characteristics, outcomes, and disposition of these patients after they leave the hospital. OBJECTIVE: To describe clinical and sociodemographic characteristics and outcomes of ICU patients who require long-term (5 days or more) mechanical ventilation while in the hospital. METHODS: A prospective, longitudinal descriptive design was used to study 57 ICU patients who required 5 days or more of continuous mechanical ventilation while in the hospital. Clinical and sociodemographic data were collected at the time of enrollment. Patients were followed up for up to 6 months after discharge from the hospital to ascertain disposition and morality. RESULTS: On average, patients had a hospital stay of almost 6 weeks and required mechanical ventilation for approximately 4 weeks; 43.9% of the patients died in the hospital. None of the patients discharged from the hospital were able to return home initially without assistance. By 6 months after discharge, more than 50% of the original sample and died, 9% resided in an institution, and 33% were living at home. CONCLUSIONS: A large percentage of ICU patients who require 5 days or more of mechanical ventilation die in the hospital, and many of those who live spend considerable time in an extended-care facility before they are discharged to their homes. These likely outcomes of patients who require long-term ventilation should be discussed with patients and their families to assist them in making informed decisions.

scholarly journals Tracheostomy and long-term mortality in ICU patients undergoing prolonged mechanical ventilation

PLoS ONE ◽  
2019 ◽  
Vol 14 (10) ◽  
pp. e0220399 ◽  
Author(s):  
Raphaël Cinotti ◽  
Sebastian Voicu ◽  
Samir Jaber ◽  
Benjamin Chousterman ◽  
Catherine Paugam-Burtz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Icu Patients ◽  
Long Term Mortality

Long-term mechanical ventilation in a pregnant woman with amyotrophic lateral sclerosis: a successful outcome

2014 ◽  
Vol 3 (1) ◽  
Author(s):  
Jezid Miranda ◽  
Betty Palacio ◽  
Jose Antonio Rojas-Suarez ◽  
Ghada Bourjeily
Keyword(s):  
Mechanical Ventilation ◽  
Amyotrophic Lateral Sclerosis ◽  
Pregnant Woman ◽  
Prolonged Mechanical Ventilation ◽  
Ventilatory Support ◽  
Care Facility ◽  
Successful Outcome ◽  
Spontaneous Preterm Birth ◽  
Lateral Sclerosis

AbstractAmyotrophic lateral sclerosis (ALS) is a progressive degenerative motor neuron disease that is rarely encountered in the obstetric population. This report describes the successful use of long-term mechanical ventilation in a pregnant woman with ALS.A 37-year-old G3P2 woman with ALS was admitted to the emergency room with shortness of breath, tachypnea, and evidence of hypoxic and hypercapnic respiratory failure at 24 weeks of gestation, precipitated by bacterial pneumonia. Antibiotic therapy, intubation, and mechanical ventilatory support were initiated, followed by an early tracheostomy as soon as the need for prolonged airway access was identified. The mother remained with prolonged mechanical ventilation until spontaneous preterm birth occurred at 32 weeks of gestation, with the vaginal delivery of a healthy infant. The mother was discharged from the intensive care unit during puerperium to continue mechanical ventilation support in a home care facility.Long-term mechanical ventilation can be successfully performed during pregnancy. Goals of oxygenation and ventilation need to be modified and customized based on the underlying condition and the status of the mother.

Chronic Comorbid Illnesses Predict the Clinical Course of 866 Patients Requiring Prolonged Mechanical Ventilation in a Long-Term, Acute-Care Hospital

2018 ◽  
Vol 35 (8) ◽  
pp. 745-754 ◽  
Author(s):  
J. Dermot Frengley ◽  
Giorgio R. Sansone ◽  
Robert J. Kaner
Keyword(s):  
Mechanical Ventilation ◽  
Acute Care ◽  
Clinical Course ◽  
Prolonged Mechanical Ventilation ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Term Survival ◽  
Group A ◽  
Chronically Critically Ill

Objective: To determine whether burdens of chronic comorbid illnesses can predict the clinical course of prolonged mechanical ventilation (PMV)patients in a long-term, acute-care hospital (LTACH). Methods: Retrospective study of 866 consecutive PMV patients whose burdens of chronic comorbid illnesses were quantified using the Cumulative Illness Rating Scale (CIRS). Based on increasing CIRS scores, 6 groups were formed and compared: group A (≤25; n = 97), group B (26-28; n = 105), group C (29-31; n = 181), group D (32-34; n = 208), group E (35-37; n = 173), and group F (>37; n = 102). Results: As CIRS scores increased from group A to group F, rates of weaning success, home discharges, and LTACH survival declined progressively from 74% to 17%, 48% to 0%, and 79% to 21%, respectively (all P < .001). Negative correlations between the mean score of each CIRS group and correspondent outcomes also supported patients’ group allocation and an accurate prediction of their clinical course (all P < .01). Long-term survival progressively declined from a median survival time of 38.9 months in group A to 3.2 months in group F ( P < .001). Compared to group A, risk of death was 75% greater in group F ( P = .03). Noteworthy, PMV patients with CIRS score <25 showed greater ability to recover and a low likelihood of becoming chronically critically ill. Diagnostic accuracy of CIRS to predict likelihood of weaning success, home discharges, both LTACH and long-term survival was good (area under the curves ≥0.71; all P <.001). Conclusions: The burden of chronic comorbid illnesses was a strong prognostic indicator of the clinical course of PMV patients. Patients with lower CIRS values showed greater ability to recover and were less likely to become chronically critically ill. Thus, CIRS can be used to help guide clinicians caring for PMV patients in transfer decisions to and from postacute care setting.

Weaning Analgosedation in Patients Requiring Prolonged Mechanical Ventilation

2021 ◽  
pp. 088506662110487
Author(s):  
Stephanie Parks Taylor ◽  
John M. Hammer ◽  
Brice T. Taylor
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Multidisciplinary Care ◽  
Potential Harm ◽  
Mechanically Ventilated ◽  
Multidisciplinary Care Team ◽  
Clinical Trial Evidence ◽  
Adults And Children ◽  
Trial Evidence

Although research supports the minimization of sedation in mechanically ventilated patients, many patients with severe acute respiratory distress syndrome (ARDS) receive prolonged opioid and sedative infusions. ICU teams face the challenge of weaning these medications, balancing the risks of sedation with the potential to precipitate withdrawal symptoms. In this article, we use a clinical case to discuss our approach to weaning analgosedation in patients recovering from long-term mechanical ventilation. We believe that a protocolized, multimodal weaning strategy implemented by a multidisciplinary care team is required to reduce potential harm from both under- and over-sedation. At present, there is no strong randomized clinical trial evidence to support a particular weaning strategy in adult ICU patients, but appraisal of the existing literature in adults and children can guide decision-making to enhance the recovery of these patients.

Prolonged mechanical ventilation and delayed weaning

2019 ◽  
pp. 243-258
Author(s):  
Patrick B. Murphy ◽  
Nicholas Hart
Keyword(s):  
Critical Care ◽  
Critical Care Unit ◽  
Prolonged Mechanical Ventilation ◽  
Daily Practice ◽  
Care Staff ◽  
Standard Textbook ◽  
Long Term Ventilation ◽  
Learning Points

This chapter is centred on a case study on long-term ventilation and weaning. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, together with relevant images, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

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