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Long-Term Return to Functional Baseline After Mechanical Ventilation in the ICU*

Wilson, Michael E., MD1,2,3; Barwise, Amelia, MBBChBAO1,2; Heise, Katherine J., APRN, CNP, MSN2,4; Loftsgard, Theodore O., APRN, CNP2,4; Dziadzko, Mikhail, MD, PhD2,5; Cheville, Andrea, MD6; Majzoub, Abdul, MD1,2; Novotny, Paul J., MS7; Gajic, Ognjen, MD, MSc1,2; Biehl, Michelle, MD, MSc2,8

doi: 10.1097/CCM.0000000000002927
Clinical Investigations

Objective: Predictors of long-term functional impairment in acute respiratory failure of all causes are poorly understood. Our objective was to assess the frequency and predictors of long-term functional impairment or death after invasive mechanical ventilation for acute respiratory failure of all causes.

Design: Population-based, observational cohort study.

Setting: Eight adult ICUs of a single center.

Patients: All adult patients from Olmsted County, Minnesota, without baseline functional impairment who received mechanical ventilation in ICUs for acute respiratory failure of all causes from 2005 through 2009.

Interventions: None.

Measurements and Main Results: In total, 743 patients without baseline functional impairment received mechanical ventilation in the ICU. At 1- and 5-year follow-up, the rates of survival with return to baseline functional ability were 61% (366/597) and 53% (356/669). Among 71 patients with new functional impairment at 1 year, 55% (39/71) had recovered and were alive without functional impairment at 5 years. Factors predictive of new functional impairment or death at 1 year were age, comorbidities, discharge to other than home, mechanical ventilation of 7 days or longer, and stroke. Of factors known at the time of intubation, the following are predictive of new functional impairment or death: age, comorbidities, nonsurgical condition, Acute Physiology and Chronic Health Evaluation III score, stroke, and sepsis. Post hoc sensitivity analyses revealed no significant change in predictor variables in patient populations when stroke was excluded or who received more than 48 hours of mechanical ventilation.

Conclusions: At 1- and 5-year follow-up, many patients who received mechanical ventilation for acute respiratory failure from all causes are no longer alive or have new moderate-to-severe functional impairment. Functional recovery between year 1 and year 5 is possible and common. Sepsis, stroke, illness severity, age, and comorbidities predict long-term functional outcome at intubation.

1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.

2METRIC (Multidisciplinary Epidemiology and Translational Research in Intensive Care), Mayo Clinic, Rochester, MN.

3Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.

4Division of Anesthesia Critical Care, Mayo Clinic, Rochester, MN.

5Department of Anesthesiology, HCL Hospital Croix Rousse, Lyon, France.

6Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.

7Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.

8Pulmonary and Critical Care Medicine, Sanford USD Medical Center, Sioux Falls, SD.

*See also p. 648.

This work was performed at the Mayo Clinic, Rochester, MN.

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Supported by the Mayo Clinic Foundation and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic. The funding sources had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; and preparation, review, or approval of the article for publication.

The authors have disclosed that they do not have any potential conflicts of interest.

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