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. 2019 Nov 4;5(1):73.
doi: 10.1186/s40981-019-0284-4.

Clinical features and outcomes of prolonged mechanical ventilation: a single-center retrospective observational study

Isao Nagata  1 , Tetsuhiro Takei  2 , Junji Hatakeyama  2 , Masafumi Toh  2 , Hiroyuki Yamada  2 , Michiko Fujisawa  2
Affiliations

Clinical features and outcomes of prolonged mechanical ventilation: a single-center retrospective observational study

Isao Nagata et al. JA Clin Rep. .

Abstract

Background: Information on epidemiology of prolonged mechanical ventilation (PMV) patients in the acute care setting in Japan is totally lacking. We aimed to investigate clinical features, impact, and long-term outcomes of PMV patients.

Methods: This was a retrospective observational study conducted in a tertiary care hospital. Adult patients who were admitted to our intensive care unit (ICU) from April 2009 to March 2014 and required mechanical ventilation (MV) for ≥ 2 days were included. PMV was defined as having MV for ≥ 21 consecutive days.

Results: Among 1282 MV patients, 93 (7.3%) required PMV, and median duration of MV was 37.0 days. Compared with the non-PMV patients, PMV patients had longer total ICU and high care unit (HCU) stay (34.0 vs. 7.0 days, p < 0.001), longer hospital stay (74.0 vs. 35.0 days, p < 0.001), and higher hospital mortality (54.8 vs. 21.4%, p < 0.001). In multivariable logistic regression analysis, emergency ICU admission and steroid use during MV were associated with PMV. The Kaplan-Meier curves for MV withdrawal and ICU/HCU discharge were almost identical. Among PMV patients, 52 (55.9%) died, 29 (31.2%) were successfully liberated from MV during hospitalization, and 12 (12.9%) still required MV at discharge.

Conclusion: In this investigation, 7.3% of the patients with MV required PMV. Most PMV patients were liberated from MV during hospitalization, while occupying critical care beds for an extended period. A nationwide survey is required to further elucidate the overall picture of PMV patients and to discuss whether specialized weaning centers to treat PMV patients are required in Japan.

Keywords: Intensive care unit; Long-term acute care; Prolonged mechanical ventilation; Weaning center.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study patients. MV, mechanical ventilation
Fig. 2
Fig. 2
Kaplan–Meier curves for survival, ICU/HCU stay, and continuation of mechanical ventilation (MV) in the patients mechanically ventilated for > 21 days (N = 93). The survival curve had a gentle slope from 21 to 90 days after initiation of MV. The curves of MV withdrawal and ICU/HCU discharge were almost identical, having an initial steep slope and transition to a gentle slope in the last third of the curves
See this image and copyright information in PMC

References

    1. Vora CS, Karnik ND, Gupta V, Nadkar MY, Shetye JV. Clinical profile of patients requiring prolonged mechanical ventilation and their outcome in a tertiary care medical ICU. J Assoc Physicians India. 2015;63(10):14–19. - PubMed
    1. Loss SH, de Oliveira RP, Maccari JG, Savi A, Boniatti MM, Hetzel MP, et al. The reality of patients requiring prolonged mechanical ventilation: a multicenter study. Revista Brasileira de terapia intensiva. 2015;27(1):26–35. doi: 10.5935/0103-507X.20150006. - DOI - PMC - PubMed
    1. Cox CE, Carson SS, Lindquist JH, Olsen MK, Govert JA, Chelluri L. Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study. Critical care (London, England) 2007;11(1):R9. doi: 10.1186/cc5667. - DOI - PMC - PubMed
    1. Estenssoro E, Gonzalez F, Laffaire E, Canales H, Saenz G, Reina R, et al. Shock on admission day is the best predictor of prolonged mechanical ventilation in the ICU. Chest. 2005;127(2):598–603. doi: 10.1378/chest.127.2.598. - DOI - PubMed
    1. Cox CE, Carson SS, Holmes GM, Howard A, Carey TS. Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993-2002. Crit Care Med. 2004;32(11):2219–2226. doi: 10.1097/01.CCM.0000145232.46143.40. - DOI - PubMed

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