title: Medical and economic implications of prolonged mechanical ventilation and expedited post-acute care.
abstract: This article describes the increasingly common phenomenon of prolonged mechanical ventilation in the context of the transition between the acute care hospital and post-acute care. Prolonged mechanical ventilation or chronic critical illness is associated with hospital mortality in the range of 20 to 40%, with median hospital length of stay ranging from 14 to 60 days. Fewer than 10% of patients are discharged home, and most hospital survivors require institutionalized post-acute care in the form of long-term acute care, skilled nursing facilities, or inpatient rehabilitation. Acute hospital readmission is common. Because of prolonged functional disabilities and multiple underlying comorbid conditions, overall 1 year mortality for prolonged mechanical ventilation patients ranges from 50 to 60%. Survivors experience significant functional limitations. The prolonged institutional care and poor long-term outcomes of these patients bring into question the cost-effectiveness of prolonged mechanical ventilation after acute illness, especially for patients with poor long-term prognoses. New measures to facilitate assessments of long-term prognosis and improve communication with surrogate decision makers may reduce the amount of ineffective care for some patients requiring prolonged mechanical ventilation.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Cox
authors.forename: Shannon S
authors.initials: SS
authors.lastname: Carson
mesh_terms: D000359:Aftercare / Q000191:economics* / Q000706:statistics & numerical data; D017281:Cost of Illness; D003422:Critical Care / Q000191:economics* / Q000706:statistics & numerical data; D016638:Critical Illness / Q000191:economics* / Q000534:rehabilitation; D006801:Humans; D007362:Intensive Care Units / Q000191:economics* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000191:economics* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D012121:Respiration, Artificial / Q000191:economics* / Q000401:mortality / Q000706:statistics & numerical data; D017741:Survivors / Q000706:statistics & numerical data; D016896:Treatment Outcome