Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study.
BACKGROUND
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 > or = 48 hours, 267 (33%) of whom received PMV based on receipt of a tracheostomy and ventilation for > or = 96 hours. A total of 114 (14%) patients met the alternate definition of PMV by being ventilated for > or = 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 > or = 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 > or = 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 > or = 21 days, > or = 96 hours with a tracheostomy, and < 96 hours, respectively.


CONCLUSIONS
Contrasting definitions of PMV capture significantly different patient populations, with > or = 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.
Cox
Christopher E
CE
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina 27710, USA. christopher.cox@duke.edu
Carson
Shannon S
SS
Lindquist
Jennifer H
JH
Olsen
Maren K
MK
Govert
Joseph A
JA
Chelluri
Lakshmipathi
L
D000203:Activities of Daily Living; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000191:economics / Q000401:mortality / Q000628:therapy*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D012121:Respiration, Artificial / Q000191:economics; D016019:Survival Analysis; D013997:Time Factors; D014139:Tracheostomy