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The Reality of Patients Requiring Prolonged Mechanical Ventilation: A Retrospective Multicenter Cohort Study
Sérgio Henrique Loss1, Roselaine Pinheiro de Oliveira2,3,6, Juçara Gasparetto Maccari2,4, Augusto Savi2, Marcio Manozzo Boniatti1, Márcio Pereira Hetzel3, Daniele Munaretto Dallegrave3, Patrícia de Campos Balzano1, Eubrando Silvestre Oliveira1, Jorge Amilton Höher3,5, André Peretti Torelly4 and Cassiano Teixeira2,3,5*1Department of Critical Care, Mãe de Deus Hospital, Brazil
2Department of Critical Care, Moinhos de Vento Hospital, Brazil
3Department of Critical Care, Central ICU of Santa Casa Hospital, Brazil
4Department of Critical Care, Santa Rita ICU of Santa Casa Hospital, Brazil
5Federal University of Health Sciences of Porto Alegre, Brazil
6University of Santa Cruz do Sul, Brazil
- *Corresponding Author:
- Cassiano Teixeira
Riveira, 355/403
Porto Alegre, RS-Brasil
Zip-Code: 90670-160
Tel: +55 (51) 3312.2608
E-mail: cassiano.rush@gmail.com
Received date: May 20, 2014; Accepted date: September 28, 2014; Published date: October 6, 2014
Citation: Loss HS, de Oliveira RP, Maccari JG, Savi A, Boniatti MM et al. (2014) The Reality of Patients Requiring Prolonged Mechanical Ventilation: A Retrospective Multicenter Cohort Study. J Palliat Care Med 4:192. doi:10.4172/2165-7386.1000192
Copyright: © 2014 Loss HS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Context: The number of patients requiring prolonged mechanical ventilation (PMV) has increased over the last decade, generating a large population of chronically ill patients. Objective: To establish the incidence of PMV in four Intensive Care Units (ICUs), and to report different characteristics, hospital outcomes, and the impact of costs and services of PMV patients (mechanical ventilation dependency = 21 days) compared with non-PMV patients (mechanical ventilation dependency < 21 days). Design, Setting, and Patients: A retrospective multicenter cohort study, including all patients admitted to four ICUs. Main Outcome Measures: Length of stay in the ICU, hospital, complications during ICU stay, and ICU and hospital mortality. Results: During study period, there were 5,287 admission episodes to the ICUs. Forty-one point five percent of these patients needed ventilatory support (n=2,197), and 218 met criteria for PMV (9.9%). Some complications developed during ICU stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of PMV. PMV patients had a significant increase in ICU mortality (absolute difference=14.2%, p<0.001), and in hospital mortality (absolute difference=19.1%, p<0.001); PMV group spent more days in the hospital after ICU discharge (26.9 ± 29.3 vs. 10.3 ± 20.4, p<0.001) and with higher costs. Conclusions: the classification of chronically critically ill patients according to the definition of PMV adopted by our study (mechanical ventilation dependency =21 days) identified patients with high risk for complications during ICU stay, high ICU and hospital stay, high death rates, as well as higher costs.
