scholarly journals The patient needing prolonged mechanical ventilation: a narrative review

2019 ◽  
Vol 13 ◽  
Author(s):  
Nicolino Ambrosino
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Training ◽  
Prolonged Mechanical Ventilation ◽  
Narrative Review ◽  
Optimal Time ◽  
Published Data ◽  
Main Body ◽  
Term Survival

Background: Progress in management has improved hospital mortality of patients admitted to the intensive care units, but also the prevalence of those patients needing weaning from prolonged mechanical ventilation, and of ventilator assisted individuals. The result is a number of difficult clinical and organizational problems for patients, caregivers and health services, as well as high human and financial resources consumption, despite poor long-term outcomes. An effort should be made to improve the management of these patients. This narrative review summarizes the main concepts in this field. Main body: There is great variability in terminology and definitions of prolonged mechanical ventilation. There have been several recent developments in the field of prolonged weaning: ventilatory strategies, use of protocols, early mobilisation and physiotherapy, specialised weaning units. There are few published data on discharge home rates, need of home mechanical ventilation, or long-term survival of these patients. Whether artificial nutritional support improves the outcome for these chronic critically ill patients, is unclear and controversial how these data are reported on the optimal time of initiation of parenteral vs enteral nutrition. There is no consensus on time of tracheostomy or decannulation. Despite several individualized, non-comparative and non-validated decannulation protocols exist, universally accepted protocols are lacking as well as randomised controlled trials on this critical issue. End of life decisions should result from appropriate communication among professionals, patients and surrogates and national legislations should give clear indications. Conclusion: Present medical training of clinicians and locations like traditional intensive care units do not appear enough to face the dramatic problems posed by these patients. The solutions cannot be reserved to professionals but must involve also families and all other stakeholders. Large multicentric, multinational studies on several aspects of management are needed.

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.

Mortality after Critical Illness

2014 ◽  
Author(s):  
Matthew Baldwin ◽  
Hannah Wunsch
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Prolonged Mechanical Ventilation ◽  
Risk Of Death ◽  
Increased Risk ◽  
Poor Nutrition ◽  
Long Term Mortality

Many critically ill patients now survive what were previously fatal illnesses, but long-term mortality after critical illness remains high. While study populations vary by country, age, intervention, or specific diagnosis, investigations demonstrate that the majority of additional deaths occur in the first 6 to 12 months after hospital discharge. Patients with diagnoses of cancer, respiratory failure, and neurological disorders leading to the need for intensive care have the highest long-term mortality, while those with trauma and cardiovascular diseases have much lower long-term mortality. Use of mechanical ventilation, older age, and a need for care in a facility after the acute hospitalization are associated with particularly high 1-year mortality among survivors of critical illnesses. Due to challenges of follow-up, less is known about causes of delayed mortality following critical illness. Longitudinal studies of survivors of pneumonia, stroke, and patients who require prolonged mechanical ventilation suggest that most debilitated survivors die from recurrent infections and sepsis. Potential biologic mechanisms for increased risk of death after a critical illness include sepsis-induced immunoparalysis, intensive care unit-acquired weakness, neuroendocrine changes, poor nutrition, and genetic variance. Studies are needed to fully understand how the severity of the acute critical illness interacts with comorbid disease, pre-illness disability, and pre-existing and acquired frailty to affect long-term mortality. Such studies will be fundamental to improve targeting of rehabilitative, therapeutic, and palliative interventions to improve both survival and quality of life after critical illness.

Thirty Percent Long Term Survival In Children with Acute Leukemia and Complications Requiring Mechanical Ventilation

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3243-3243
Author(s):  
Daniel Steinbach ◽  
Bernhard Wilhelm ◽  
Hans-Rudolf Kiermaier ◽  
Ursula Creutzig ◽  
Martin Schrappe ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Acute Leukemia ◽  
Conflicts Of Interest ◽  
Lymphoblastic Leukemia ◽  
Serious Adverse Events ◽  
Term Survival ◽  
Long Term Survival ◽  
Cardiac Resuscitation

Abstract Abstract 3243 Objective: Previous reports indicated that short term prognosis for patients with malignant diseases and serious adverse events requiring mechanical ventilation (SAEV) is not dismal any more. The purpose of this study was to determine whether patients who survive such complications can also achieve long term cure from leukemia. It might influence end-of-live decisions on the intensive care unit if patients with an SEAV only survive intensive care to succumb to relapse. Patients and Methods: We report the outcome of children with SAEV treated in the multicenter studies ALL-BFM 95 and AML-BFM 98. Data from 1182 patients with acute lymphoblastic leukemia (ALL) and 332 patients with acute myeloid leukemia (AML) were analyzed. 88 patients (51 ALL; 37 AML) developed an SAEV. Results: The prognosis was almost identical in ALL and AML (50% survival of SAEV; 30% overall survival after 5 years). This was independent from the time between diagnosis of leukemia and SAEV. Even children who required hemodialysis (n=14) or cardiac resuscitation (n=16) achieved 20% long term survival but no patient survived (n=16) who fulfilled more than 3 out of 6 identified risk factors: age≥10 years, high risk leukemia, C-reactive Protein≥150mg/l, administration of inotropic infusion, cardiac resuscitation, and hemodialysis. Conclusions: To our knowledge, this is the first report about cure rates in a malignant disease after successful treatment of SAEV. Our results show that intensive care medicine contributes to short and long term survival of children with leukemia. Sixty percent of all children with acute leukemia who survive an SAEV achieve long term cure. However, we could also identify risk features that still indicate a devastating prognosis. Disclosures: No relevant conflicts of interest to declare.

scholarly journals How prolonged mechanical ventilation is a neglected disease in chest medicine: a study of prolonged mechanical ventilation based on 6 years of experience in Taiwan

2019 ◽  
Vol 13 ◽  
pp. 175346661987855
Author(s):  
Chienhsiu Huang
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Survival Rate ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Prolonged Mechanical Ventilation ◽  
Survival Rates ◽  
Term Survival ◽  
Long Term Survival

Background: An increasing number of patients require prolonged mechanical ventilation (PMV) to survive recovery from critical care. It should be emphasized that PMV is a neglected disease in chest medicine. We investigated 6 years of clinical outcomes and long-term survival rates of patients who required PMV. Methods: We analyzed retrospectively data from patients in respiratory care center (RCC) to investigate the main causes of respiratory failure leading patients to require PMV. We also studied the factors that influence the ventilator weaned rate, factors that influence the long-term ventilator dependence of patients who require PMV, as well as patients’ hospital mortality and long-term survival rates. Results: A total of 574 patients were admitted to RCC during the 6 years. Of these, 428 patients (74.6%) were older than 65 years. A total of 391 patients (68.1%) were successfully weaned from the ventilator while 83 patients (14.4%) were unsuccessfully weaned. A total of 95 patients (16.6%) died during RCC hospitalization. The most common cause of acute respiratory failure leading to patients requiring PMV was pneumonia. The factor that affected whether patients were successfully weaned from the ventilator was the cause of the respiratory failure that lead patients to require PMV. Our hospital mortality rate was 32.4%; the 1-year survival rate was 24.3%. There was a strong correlation between higher patient age and higher hospital mortality rate and poor 1-year survival rate. Patients with no comorbidity demonstrated good 1-year survival rates. Patients with four comorbidities and patients with end-stage renal disease requiring hemodialysis comorbidity showed poor 1-year survival rates. Conclusions: The factor that affected whether patients were successfully weaned from the ventilator was the cause of the respiratory failure that lead patients to require PMV. Older patients, patients with renal failure requiring hemodialysis, and those with numerous comorbidities demonstrated poor long-term survival. The reviews of this paper are available via the supplemental material section.

scholarly journals The long term survival of successfully weaned prolonged mechanical ventilation patients

2020 ◽  
Author(s):  
Chienhsiu Huang
Keyword(s):  
Mechanical Ventilation ◽  
End Of Life ◽  
Prolonged Mechanical Ventilation ◽  
Do Not Resuscitate ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Long Term Survival ◽  
To Receive

Abstract Background Over six years, five hundred and seventy-four patients were admitted to the respiratory care center. Three hundred and ninety-one patients were successfully weaned from the ventilator. How is the long term outcome of these successfully weaned prolonged mechanical ventilation patients? Very few articles were discussing the long term outcome of successfully weaned prolonged mechanical ventilation patients. We will explore this issue in-depth in this article. Methods We analyzed retrospective data from successfully weaned prolonged mechanical ventilation patients to investigate the clinical variables, discharged status, long term survival, the cause of death, end-of-life decisions. Results We can further gather long term follow-up data on 243 patients. The factors between patients who died in the ward and those who survived ≥1 year revealed the poorer survival of patients who died in the ward was due to a higher percentage of end-stage renal disease comorbidity, a higher percentage of malignant comorbidity, higher percentage of ≥ four comorbidities and a higher percentage of signed do-not-resuscitate / do-not-intubate orders. The factors between patients who survived <1 year and those who survived ≥1 year revealed the poorer survival of patients who survived <1 year was due to older age, a higher percentage of signed do-not-resuscitate / do-not-intubate orders. That 81 patients (33.3%) who signed a do-not-resuscitate / do-not-intubate orders, indicates that, at most, 66.7% of survivors were willing to receive mechanical ventilation again. Conclusion The end-of-life decision (signed do-not-resuscitate / do-not-intubate orders) is one of the major influence factors of long term survival of successfully weaned prolonged mechanical ventilation patients. In all, 81 patients (33.3%) in our study signed do-not-resuscitate / do-not-intubate orders, meaning that, at most, 66.7% of survivors were willing to receive mechanical ventilation again.

scholarly journals A retrospective clinical observation of long-term survival in patients after prolonged mechanical ventilation

2020 ◽  
Author(s):  
Chienhsiu Huang
Keyword(s):  
Mechanical Ventilation ◽  
Survival Rate ◽  
Prolonged Mechanical Ventilation ◽  
Survival Rates ◽  
Respiratory Care ◽  
Term Survival ◽  
Long Term Survival ◽  
Lung Cancer Patients ◽  
Care Ward

Abstract Background The 1-year survival rate of patients on prolonged mechanical ventilation was 29-42% before 2000. By 2012, Carson reported the 1-year survival rate of prolonged mechanical ventilation patients was 52%, an unsatisfactory improvement in survival time. We explored the long-term survival rate of prolonged mechanical ventilation patients at our hospital, 2012-2017. Methods We analyzed retrospectively data from our respiratory care center patients to investigate the discharge status, long-term survival rate, and cause of death. We also compared the 5-year survival rates of prolonged mechanical ventilation patients and our hospital lung cancer patients. Results Five hundred seventy-four patients were admitted to respiratory care center during the study period. The long-term follow-up data of 403 prolonged mechanical ventilation, including 186 patients died in the hospital, 157 discharged prolonged mechanical ventilation patients, and 60 respiratory care ward patients until October 30, 2018. The 1-year survival rate of all prolonged mechanical ventilation patients, discharged prolonged mechanical ventilation patients, and respiratory care ward patients were 24.3%, 50.3%, and 31.7%, respectively. The 5-year survival rates of all prolonged mechanical ventilation patients, discharged prolonged mechanical ventilation patients, and respiratory care ward patients were 18.1%, 40.05%, and 11.7%, respectively. Successful weaning from mechanical ventilation was a key factor in the long-term survival of prolonged mechanical ventilation patients. The 5-year survival rate of discharged prolonged mechanical ventilation patients was better than that of all lung cancer patients. The 5-year survival rates of all prolonged mechanical ventilation patients and respiratory care ward patients were similar to that of stage IV lung cancer patients. Conclusions Prolonged mechanical ventilation patients had the worst long-term survival rate of all patients with chest diseases in our hospital. Successful weaning from the mechanical ventilator was most important factors for improving long-term outcomes in prolonged mechanical ventilation patients.

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