Long-term outcome and health-related quality of life in difficult-to-wean patients with and without ventilator dependency at ICU discharge: a retrospective cohort study.
BACKGROUND
Long-term outcome and quality of life (QOL) in patients requiring prolonged mechanical ventilation after failure to wean in the ICU is scarcely documented. We aimed to evaluate long-term survival and QOL in patients discharged from the ICU with a tracheostomy for difficult weaning, and with or without ventilator dependency at ICU discharge.


METHODS
We retrospectively investigated post-ICU trajectories and survival in patients requiring tracheostomy for difficult weaning admitted to the medical ICU of a tertiary center between 1999 and 2013, discriminating between patients who were ventilator dependent or were weaned at ICU discharge. In 2014, a QOL assessment was done in survivors with the use of the Short Form Health Survey (SF-36) and the Severe Respiratory Insufficiency questionnaire.


RESULTS
A total of 114 patients was included, of whom 59 were ventilator dependent and 55 were weaned at ICU discharge. One-year survival rates were 73 % and 69 %, respectively. Overall QOL scores for physical functioning were low, and not significantly different between patients ventilated and those weaned at ICU discharge; scores for social functioning and mental health were less below norm and similar between both groups.


CONCLUSIONS
Long-term survival in patients discharged from the ICU with tracheostomy and ventilator dependency after failure to wean was not significantly different from that of patients with tracheostomy and weaned at ICU discharge. Despite the physical QOL scores being low in both groups, mental QOL was acceptable. Given the intrinsic limitations of this retrospective study, prospective and preferentially multicenter studies are required to confirm these preliminary results.
Intensive Care Department, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium. pieter.depuydt@ugent.be.|Heymans Institute of Pharmacology, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium. pieter.depuydt@ugent.be.
P
P
Depuydt
Intensive Care Department, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium.
S
S
Oeyen
Ghent University, Sint-Pietersnieuwstraat 10, Ghent, 9000, Belgium.
S
S
De Smet
Ghent University, Sint-Pietersnieuwstraat 10, Ghent, 9000, Belgium.
S
S
De Raedt
Intensive Care Department, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium.
D
D
Benoit
Intensive Care Department, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium.
J
J
Decruyenaere
Department of Respiratory Diseases, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium.
E
E
Derom
Prolonged mechanical ventilation; Quality-of-life; Tracheostomy
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