Long-Term Outcome after Prolonged Mechanical Ventilation. A Long-Term Acute-Care Hospital Study

• Published in: American journal of respiratory and critical care medicine Vol. 199; no. 12; pp. 1508 - 1516
• Main Authors: Jubran, Amal, Grant, Brydon J B, Duffner, Lisa A, Collins, Eileen G, Lanuza, Dorothy M, Hoffman, Leslie A, Tobin, Martin J
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 15.06.2019
• Subjects: Aged; Clinical trials; Critical care; Critical Care Nursing - methods; Critical Care Nursing - statistics & numerical data; Female; Hospitals; Humans; Intensive care; Longitudinal Studies; Male; Middle Aged; Muscle function; Original; Ostomy; Patients; Prospective Studies; Quality of life; Questionnaires; Respiration, Artificial - nursing; Respiration, Artificial - statistics & numerical data; Time Factors; Ventilator Weaning - statistics & numerical data; Ventilators; Weaning; New York; Pittsburgh Pennsylvania; Chicago Illinois; Illinois; Wisconsin; prolonged mechanical ventilation; respiratory muscles; handgrip strength; survival
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201806-1131OC

Patients managed at a long-term acute-care hospital (LTACH) for weaning from prolonged mechanical ventilation are at risk for profound muscle weakness and disability. To investigate effects of prolonged ventilation on survival, muscle function, and its impact on quality of life at 6 and 12 months after LTACH discharge. This was a prospective, longitudinal study conducted in 315 patients being weaned from prolonged ventilation at an LTACH. At discharge, 53.7% of patients were detached from the ventilator and 1-year survival was 66.9%. On enrollment, maximum inspiratory pressure (Pi ) was 41.3 (95% confidence interval, 39.4-43.2) cm H O (53.1% predicted), whereas handgrip strength was 16.4 (95% confidence interval, 14.4-18.7) kPa (21.5% predicted). At discharge, Pi did not change, whereas handgrip strength increased by 34.8% (  < 0.001). Between discharge and 6 months, handgrip strength increased 6.2 times more than did Pi . Between discharge and 6 months, Katz activities-of-daily-living summary score improved by 64.4%; improvement in Katz summary score was related to improvement in handgrip strength (  = -0.51;  < 0.001). By 12 months, physical summary score and mental summary score of 36-item Short-Form Survey returned to preillness values. When asked, 84.7% of survivors indicated willingness to undergo mechanical ventilation again. Among patients receiving prolonged mechanical ventilation at an LTACH, 53.7% were detached from the ventilator at discharge and 1-year survival was 66.9%. Respiratory strength was well maintained, whereas peripheral strength was severely impaired throughout hospitalization. Six months after discharge, improvement in muscle function enabled patients to perform daily activities, and 84.7% indicated willingness to undergo mechanical ventilation again.