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Multicenter Study
. 2020 Feb 21;20(1):44.
doi: 10.1186/s12871-020-0942-0.

Predictors of 1-year mortality in patients on prolonged mechanical ventilation after surgery in intensive care unit: a multicenter, retrospective cohort study

Yueming Sun  1 , Shuangling Li  2 , Shupeng Wang  3 , Chen Li  3 , Gang Li  3 , Jiaxuan Xu  4 , Hongzhi Wang  4 , Fei Liu  5 , Gaiqi Yao  5 , Zhigang Chang  6 , Yalin Liu  6 , Meixia Shang  7 , Dongxin Wang  1
Affiliations
Multicenter Study

Predictors of 1-year mortality in patients on prolonged mechanical ventilation after surgery in intensive care unit: a multicenter, retrospective cohort study

Yueming Sun et al. BMC Anesthesiol. .

Abstract

Objectives: The requirement of prolonged mechanical ventilation (PMV) is associated with increased medical care demand and expenses, high early and long-term mortality, and worse life quality. However, no study has assessed the prognostic factors associated with 1-year mortality among PMV patients, not less than 21 days after surgery. This study analyzed the predictors of 1-year mortality in patients requiring PMV in intensive care units (ICUs) after surgery.

Methods: In this multicenter, respective cohort study, 124 patients who required PMV after surgery in the ICUs of five tertiary hospitals in Beijing between January 2007 and June 2016 were enrolled. The primary outcome was the duration of survival within 1 year. Predictors of 1-year mortality were identified with a multivariable Cox proportional hazard model. The predictive effect of the ProVent score was also validated.

Results: Of the 124 patients enrolled, the cumulative 1-year mortality was 74.2% (92/124). From the multivariable Cox proportional hazard analysis, cancer diagnosis (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.37-3.35; P < 0.01), no tracheostomy (HR 2.01, 95% CI 1.22-3.30; P < 0.01), enteral nutrition intolerance (HR 1.88, 95% CI 1.19-2.97; P = 0.01), blood platelet count ≤150 × 109/L (HR 1.77, 95% CI 1.14-2.75; P = 0.01), requirement of vasopressors (HR 1.78, 95% CI 1.13-2.80; P = 0.02), and renal replacement therapy (HR 1.71, 95% CI 1.01-2.91; P = 0.047) on the 21st day of mechanical ventilation (MV) were associated with shortened 1-year survival.

Conclusions: For patients who required PMV after surgery, cancer diagnosis, no tracheostomy, enteral nutrition intolerance, blood platelet count ≤150 × 109/L, vasopressor requirement, and renal replacement therapy on the 21st day of MV were associated with shortened 1-year survival. The prognosis in PMV patients in ICUs can facilitate the decision-making process of physicians and patients' family members on treatment schedule.

Keywords: 1-year mortality; Intensive care unit; Postoperative patients; Prolonged mechanical ventilation.

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Conflict of interest statement

The authors declare that they have no financial or non-financial competing of interest.

Figures

Fig. 1
Fig. 1
Flow chart of the study. ICU, intensive care unit. MV, mechanical ventilation. PMV, prolonged mechanical ventilation. aIncluded Guillain-Barré syndrome, muscular dystrophy, amyotrophic lateral sclerosis and myasthenia gravis
Fig. 2
Fig. 2
Comparison between the combination of multivariate factors and the ProVent Score in predicting 1-year mortality
See this image and copyright information in PMC

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