An increasing number of patients require prolonged mechanical ventilation (PMV), which is associated with high morbidity and poor long-term survival, but there are few data regarding the incidence and outcome of PMV patients from a community perspective.
METHODS:
We retrospectively reviewed the electronic medical records of adult Olmsted county, Minnesota, residents admitted to the intensive care units at the 2 Mayo Clinic Rochester hospitals from January 1, 2003, to December 31, 2007, who underwent tracheostomy for PMV.
RESULTS:
Sixty-five patients, median age 68 years (interquartile range [IQR] 49–80 y), 39 male, underwent tracheostomy for PMV, resulting in an age-adjusted incidence of 13 (95% CI 10–17) per 100,000 patient-years at risk. The median number of days on mechanical ventilation was 24 days (IQR 18–37 d). Forty-six patients (71%) survived to hospital discharge, and 36 (55%) were alive at 1-year follow-up. After adjusting for age and baseline severity of illness, the presence of COPD was independently associated with 1-year mortality (hazard ratio 3.4, 95% CI 1.4–8.2%).
CONCLUSIONS:
There was a considerable incidence of tracheostomy for PMV. The presence of COPD was an independent predictor of 1-year mortality.
CarsonSS. Outcomes of prolonged mechanical ventilation. Curr Opin Crit Care, 2006; 12(5):405–411.
2.
CoxCE, CarsonSS, HolmesGM, HowardA, CareyTS. Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993–2002. Crit Care Med, 2004; 32(11):2219–2226.
3.
EngorenM, Arslanian-EngorenC, Fenn-BudererN. Hospital and long-term outcome after tracheostomy for respiratory failure. Chest, 2004; 125(1):220–227.
4.
EngorenMC, Arslanian-EngorenCM. Outcome after tracheostomy for respiratory failure in the elderly. J Intensive Care Med, 2005; 20(2):104–110.
5.
SpicherJE, WhiteDP. Outcome and function following prolonged mechanical ventilation. Arch Intern Med, 1987; 147(3):421–425.
6.
GraceyDR, HardyDC, KoenigGE. The chronic ventilator-dependent unit: a lower-cost alternative to intensive care. Mayo Clin Proc, 2000; 75(5):445–449.
7.
ChelluriL, ImKA, BelleSH, SchulzR, RotondiAJ, DonahoeMP, et al. Long-term mortality and quality of life after prolonged mechanical ventilation. Crit Care Med, 2004; 32(1):61–69.
8.
ScheinhornDJ, HassenpflugMS, VottoJJ, ChaoDC, EpsteinSK, DoigGS, KnightEB, PetrakRA. Post-ICU mechanical ventilation at 23 long-term care hospitals: a multicenter outcomes study. Chest, 2007; 131(1):85–93.
9.
WagnerDP. Economics of prolonged mechanical ventilation. Am Rev Respir Dis, 1989; 140(2 Pt 2):S14–S18.
10.
CoxCE, CarsonSS, GovertJA, ChelluriL, SandersGD. An economic evaluation of prolonged mechanical ventilation. Crit Care Med, 2007; 35(8):1918–1927.
11.
SeferianEG, AfessaB, GajicO, KeeganMT, HubmayrRD. Comparison of community and referral intensive care unit patients in a tertiary medical center: evidence for referral bias in the critically ill. Crit Care Med, 2008; 36(10):2779–2786.
12.
RanaS, PendemS, PogodzinskiMS, HubmayrRD, GajicO. Tracheostomy in critically ill patients. Mayo Clin Proc, 2005; 80(12):1632–1638.
13.
SeferianEG, AfessaB. Demographic and clinical variation of adult intensive care unit utilization from a geographically defined population. Crit Care Med, 2006; 34(8):2113–2119.
14.
KleinRJ, SchoenbornCA. Age adjustment using the 2000 projected US population. Healthy People 2010 Stat Notes, 2001; 20(1):1–10.
15.
KnausWA, WagnerDP, DraperEA, ZimmermanJE, BergnerM, BastosPG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest, 1991; 100(6):1619–1636.
16.
PauwelsRA, BuistAS, CalverleyPM, JenkinsCR, HurdSS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med, 2001; 163(5):1256–1276.
17.
PuavilaiG, ChanprasertyotinS, SriphrapradaengA. Diagnostic criteria for diabetes mellitus and other categories of glucose intolerance: 1997 criteria by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (ADA), 1998 WHO consultation criteria, and 1985 WHO criteria. World Health Organization. Diabetes Res Clin Pract, 1999; 44(1):21–26.
PerrinC, UnterbornJN, AmbrosioCD, HillNS. Pulmonary complications of chronic neuromuscular diseases and their management. Muscle Nerve, 2004; 29(1):5–27.
20.
ArozullahAM, DaleyJ, HendersonWG, KhuriSF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg, 2000; 232(2):242–253.
21.
CharlsonME, PompeiP, AlesKL, MacKenzieCR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987; 40(5):373–383.
22.
BernardGR, ArtigasA, BrighamKL, CarletJ, FalkeK, HudsonL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med, 1994; 149(3 Pt 1):818–824.
23.
AntonelliM, LevyM, AndrewsPJ, ChastreJ, HudsonLD, ManthousC, et al. Hemodynamic monitoring in shock and implications for management. International Consensus Conference, Paris, France, 27-28 April 2006. Intensive Care Med, 2007; 33(4):575–590.
24.
CombesA, CostaMA, TrouilletJL, BaudotJ, MokhtariM, GibertC, ChastreJ. Morbidity, mortality, and quality-of-life outcomes of patients requiring ≥14 days of mechanical ventilation. Crit Care Med, 2003; 31(5):1373–1381.
25.
DouglasSL, DalyBJ, GordonN, BrennanPF. Survival and quality of life: short-term versus long-term ventilator patients. Crit Care Med, 2002; 30(12):2655–2662.
26.
GraceyDR, NaessensJM, KrishanI, MarshHM. Hospital and posthospital survival in patients mechanically ventilated for more than 29 days. Chest, 1992; 101(1):211–214.
27.
CoxCE, CarsonSS, LindquistJH, OlsenMK, GovertJA, ChelluriL. Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study. Crit Care, 2007; 11(1):R9.
28.
CarsonSS, GarrettJ, HansonLC, LanierJ, GovertJ, BrakeMC, LanducciDL, CoxCE, CareyTS. A prognostic model for one-year mortality in patients requiring prolonged mechanical ventilation. Crit Care Med, 2008; 36(7):2061–2069.
29.
MacIntyreNR, EpsteinSK, CarsonS, ScheinhornD, ChristopherK, MuldoonS. Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. Chest, 2005; 128(6):3937–3954.
30.
PilcherDV, BaileyMJ, TreacherDF, HamidS, WilliamsAJ, DavidsonAC. Outcomes, cost and long term survival of patients referred to a regional weaning centre. Thorax, 2005; 60(3):187–192.
31.
BigatelloLM, StelfoxHT, BerraL, SchmidtU, GettingsEM. Outcome of patients undergoing prolonged mechanical ventilation after critical illness. Crit Care Med, 2007; 35(11):2491–2497.
32.
AboussouanLS, LattinCD, KlineJL. Determinants of long-term mortality after prolonged mechanical ventilation. Lung, 2008; 186(5):299–306.
33.
Ai-PingC, LeeKH, LimTK. In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD: a retrospective study. Chest, 2005; 128(2):518–524.
34.
BolesJM, BionJ, ConnorsA, HerridgeM, MarshB, MelotC, et al. Weaning from mechanical ventilation. Eur Respir J, 2007; 29(5):1033–1056.
35.
ScheinhornDJ, HassenpflugMS, VottoJJ, ChaoDC, EpsteinSK, DoigGS, et al. Ventilator-dependent survivors of catastrophic illness transferred to 23 long-term care hospitals for weaning from prolonged mechanical ventilation. Chest, 2007; 131(1):76–84.
36.
SchonhoferB, EuteneuerS, NavaS, SuchiS, KohlerD. Survival of mechanically ventilated patients admitted to a specialised weaning centre. Intensive Care Med, 2002; 28(7):908–916.
37.
MarcheseS, Lo CocoD, Lo CocoA. Outcome and attitudes toward home tracheostomy ventilation of consecutive patients: a 10-year experience. Respir Med, 2008; 102(3):430–436.
EngorenM, Arslanian-EngorenC. Hospital and long-term outcome of trauma patients with tracheostomy for respiratory failure. Am Surg, 2005; 71(2):123–127.
