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Long-term mortality and quality of life after prolonged mechanical ventilation*

Chelluri, Lakshmipathi MD, MPH; Im, Kyung Ah MS; Belle, Steven H. PhD; Schulz, Richard PhD; Rotondi, Armando J. PhD; Donahoe, Michael P. MD; Sirio, Carl A. MD; Mendelsohn, Aaron B. PhD; Pinsky, Michael R. MD

doi: 10.1097/01.CCM.0000098029.65347.F9
CLINICAL INVESTIGATIONS
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Objective To describe and identify factors associated with mortality rate and quality of life 1 yr after prolonged mechanical ventilation.

Design Prospective, observational cohort study with patient recruitment over 26 months and follow-up for 1 yr.

Setting Intensive care units at a tertiary care university hospital.

Patients Adult patients receiving prolonged mechanical ventilation.

Interventions None.

Measurements and Main Results We measured mortality rate and functional status, defined as the inability to perform instrumental activities of daily living (IADLs) 1 yr following prolonged mechanical ventilation. The study enrolled 817 patients. Their median age was 65 yrs, 46% were women, and 44% were alive at 1 yr. Median ages at baseline of 1-yr survivors and nonsurvivors were 53 and 71 yrs, respectively. At the time of admission to the hospital, survivors had fewer comorbidities, lower severity of illness score, and less dependence compared with nonsurvivors. Severity of illness on admission to the intensive care unit and prehospitalization functional status had a significant association with short-term mortality rate, whereas age and comorbidities were related to long-term mortality. Fifty-seven percent of the surviving patients needed caregiver assistance at 1 yr of follow-up. The odds of having IADL dependence at 1-yr among survivors was greater in older patients (odds ratio 1.04 for 1-yr increase in age) and those with IADL dependence before hospitalization (odds ratio 2.27).

Conclusions Mortality rate after prolonged mechanical ventilation is high. Long-term mortality rate is associated with older age and poor prehospitalization functional status. Many survivors needed assistance after discharge from the hospital, and more than half still required caregiver assistance at 1 yr. Interventions providing support for caregivers and patients may improve the functional status and quality of life of both groups and thus need to be evaluated.

From the Departments of Critical Care Medicine (LC, AJR, CAS, MRP) and Medicine (MPD), University of Pittsburgh School of Medicine, the Graduate School of Public Health (KAI, SHB, ABM), and the University Center for Social and Urban Research (RS), University of Pittsburgh, Pittsburgh PA

Supported, in part, by grant RO1 AG11979 from the National Institute on Aging.

Address requests for reprints to: Lakshmipathi Chelluri, MD, MPH, Department of Critical Care Medicine, University of Pittsburgh Medical Center 637, 6th Floor Scaife Hall, Pittsburgh PA 15261. E-mail: Chelluril@ccm.upmc.edu

Prolonged mechanical ventilation carries a high long-term mortality rate, and mortality rate is associated with older age and poor prehospitalization functional status.

© 2004 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins