title: The reality of patients requiring prolonged mechanical ventilation: a multicenter study.
abstract: OBJECTIVE
  The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ≥ 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency < 21 days).
  
  
  METHODS
  This study was a multicenter cohort study of all patients who were admitted to four intensive care units. The main outcome measures were length of stay in the intensive care unit, hospital, complications during intensive care unit stay, and intensive care unit and hospital mortality.
  
  
  RESULTS
  There were 5,287 admissions to the intensive care units during study period. Some of these patients (41.5%) needed ventilatory support (n = 2,197), and 218 of the patients met criteria for prolonged mechanical ventilation (9.9%). Some complications developed during intensive care unit stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of prolonged mechanical ventilation. Prolonged mechanical ventilation patients had a significant increase in intensive care unit mortality (absolute difference = 14.2%, p < 0.001) and hospital mortality (absolute difference = 19.1%, p < 0.001). The prolonged mechanical ventilation group spent more days in the hospital after intensive care unit discharge (26.9 ± 29.3 versus 10.3 ± 20.4 days, p < 0.001) with higher costs.
  
  
  CONCLUSIONS
  The classification of chronically critically ill patients according to the definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation dependency ≥ 21 days) identified patients with a high risk for complications during intensive care unit stay, longer intensive care unit and hospital stays, high death rates, and higher costs.
authors.affiliation: Departamento de Terapia Intensiva, Hospital Mãe de Deus, Porto Alegre, RS, Brasil.
authors.forename: Sérgio Henrique
authors.initials: SH
authors.lastname: Loss
authors.affiliation: Departamento de Terapia Intensiva, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil.
authors.forename: Roselaine Pinheiro
authors.initials: RP
authors.lastname: de Oliveira
authors.affiliation: Departamento de Terapia Intensiva, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil.
authors.forename: Juçara Gasparetto
authors.initials: JG
authors.lastname: Maccari
authors.affiliation: Departamento de Terapia Intensiva, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil.
authors.forename: Augusto
authors.initials: A
authors.lastname: Savi
authors.affiliation: Departamento de Terapia Intensiva, Hospital Mãe de Deus, Porto Alegre, RS, Brasil.
authors.forename: Marcio Manozzo
authors.initials: MM
authors.lastname: Boniatti
authors.affiliation: Departamento de Terapia Intensiva, Unidade Central de Terapia Intensiva, Hospital Irmandade Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil.
authors.forename: Márcio Pereira
authors.initials: MP
authors.lastname: Hetzel
authors.affiliation: Departamento de Terapia Intensiva, Unidade Central de Terapia Intensiva, Hospital Irmandade Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil.
authors.forename: Daniele Munaretto
authors.initials: DM
authors.lastname: Dallegrave
authors.affiliation: Departamento de Terapia Intensiva, Hospital Mãe de Deus, Porto Alegre, RS, Brasil.
authors.forename: Patrícia de Campos
authors.initials: Pde C
authors.lastname: Balzano
authors.affiliation: Departamento de Terapia Intensiva, Hospital Mãe de Deus, Porto Alegre, RS, Brasil.
authors.forename: Eubrando Silvestre
authors.initials: ES
authors.lastname: Oliveira
authors.affiliation: Departamento de Terapia Intensiva, Unidade Central de Terapia Intensiva, Hospital Irmandade Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil.
authors.forename: Jorge Amilton
authors.initials: JA
authors.lastname: Höher
authors.affiliation: Departamento de Terapia Intensiva, Unidade de Terapia Intensiva Santa Rita, Hospital Irmandade Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil.
authors.forename: André Peretti
authors.initials: AP
authors.lastname: Torelly
authors.affiliation: Departamento de Terapia Intensiva, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil.
authors.forename: Cassiano
authors.initials: C
authors.lastname: Teixeira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors