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Quality of life in survivors of prolonged mechanical ventilatory support

Chatila, Wissam MD; Kreimer, Diane T. RN, RRT; Criner, Gerard J. MD, FCCP

Clinical Investigations

Objective: To examine the long-term quality of life (QOL) in a group of patients after prolonged mechanical ventilatory support.

Design: Prospective cohort study.

Setting: Outpatient follow-up.

Patients: Survivors of prolonged mechanical ventilatory support who were discharged from a ventilator rehabilitation unit (VRU).

Interventions: Measurement of health-related QOL using the Sickness Impact Profile (SIP).

Measurements and Main Results : Forty-six patients were contacted approximately 2 yrs after their discharge from the VRU and asked to complete the SIP. Twenty-five patients (age, 59 ± 17 yrs; duration of mechanical ventilatory support, 45 ± 36 days [mean ± sd]) agreed to participate in this study and completed the SIP questionnaire 23 ± 18 months after their discharge from the VRU. Patients’ VRU stay was 29 ± 21 days. Two patients were discharged with nocturnal ventilatory support, and the rest were completely weaned of mechanical ventilatory support before discharge. Fifteen patients (60%) were discharged to home, eight patients (32%) were discharged to a rehabilitation facility, and two patients (8%) were discharged to a skilled-care facility. Most patients had mild dysfunction, and the global SIP score was 12 ± 10, the physical dimension score was 12 ± 12, and the psychosocial dimension score was 9 ± 11 (SIP scores range from 0 to 100, with higher scores indicating worse QOL). Subgroup analysis showed that postoperative patients had lower SIP scores compared with patients with chronic respiratory diseases (global SIP, 7 ± 6 vs. 19 ± 8;p < .05). Moreover, the patients in the postoperative group were older, but had similar SIP scores as patients who had acute lung injury (17 ± 15). Global SIP scores correlated with age (r = −.40;p = .046), but not with duration of mechanical ventilatory support (r = −.23) or VRU admission Acute Physiology and Chronic Health Evaluation II scores (r = −.39;p = .06).

Conclusions: In survivors of prolonged mechanical ventilatory support, using specific selection criteria shows that there is minimal impairment in the QOL at long-term follow-up. Although some patients continue to have moderate to severe limitations, it is the cause of respiratory failure and the underlying disease, rather than duration of ventilatory support, that have a significant impact on QOL.

From the Division of Pulmonary and Critical Care Medicine, the Department of Medicine, Temple University School of Medicine, Philadelphia, PA.

Supported, in part, by a grant from the Health Care Financing Administration (29-P-99401/3-01).

Address requests for reprints to: Wissam Chatila, MD, Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, 7 PP, Temple University School of Medicine, 3401 N Broad Street, Philadelphia, PA 19140. E-mail: wissam@pol.net

Our data demonstrate that prolonged ventilatory support does not preclude adequate recovery and good self-reported quality of life in selected intensive care unit patients.

© 2001 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins