title: Relationship of the Duration of Ventilator Support to Successful Weaning and Other Clinical Outcomes in 437 Prolonged Mechanical Ventilation Patients.
abstract: OBJECTIVE
  To investigate the relationships between durations of ventilator support and weaning outcomes of prolonged mechanical ventilation (PMV) patients.
  
  
  METHODS
  Cohort study of 957 PMV patients sequentially admitted to a long-term acute care hospital (LTACH). The study population was 437 PMV patients who underwent weaning, having achieved ≥4 hours of sustained spontaneous breathing. They were divided into tertiles of mechanical ventilation (MV) durations and compared for differences (tertile A: 21-58 days, n = 146; tertile B: 59-103 days, n = 147; and tertile C: ≥104 days, n = 144).
  
  
  RESULTS
  Tertiles showed comparable weaning success rates and survival. As MV durations increased, LTACH postweaning days became progressively greater, whereas decannulations and discharge physical function diminished, and home discharges decreased while nursing facility discharges increased (all P < .001). Patients with lower physical function before critical illness or greater burdens of comorbidities were least likely to be weaned (all P < .001). Younger ages, lower comorbidity burdens, neurological diagnoses, higher admission prealbumin levels, and successful weaning, each independently reduced the risk of death (all P < .01).
  
  
  CONCLUSIONS
  Durations of MV did not affect weaning success or survival, although deleterious effects were found in discharges, decannulations, LTACH postweaning days, and discharge physical function. Durations of MV alone should not guide transfer decisions for subsequent continuing care.
authors.affiliation: 1 Clinical Outcomes Research Group, Coler Rehabilitation and Nursing Care Center, New York, NY, USA.
authors.forename: Giorgio R
authors.initials: GR
authors.lastname: Sansone
authors.affiliation: 1 Clinical Outcomes Research Group, Coler Rehabilitation and Nursing Care Center, New York, NY, USA.|2 Division of Geriatrics and Gerontology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: J Dermot
authors.initials: JD
authors.lastname: Frengley
authors.affiliation: 1 Clinical Outcomes Research Group, Coler Rehabilitation and Nursing Care Center, New York, NY, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vecchione
authors.affiliation: 1 Clinical Outcomes Research Group, Coler Rehabilitation and Nursing Care Center, New York, NY, USA.
authors.forename: Merlin G
authors.initials: MG
authors.lastname: Manogaram
authors.affiliation: 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.|4 Department of Genetic Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Kaner
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010351:Patient Discharge; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods / Q000706:statistics & numerical data
keywords: critical care; duration of ventilator support; long-term survival; prolonged mechanical ventilation; weaning outcomes