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Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study.

Publication ,  Journal Article
Cox, CE; Carson, SS; Lindquist, JH; Olsen, MK; Govert, JA; Chelluri, L ...
Published in: Crit Care
2007

INTRODUCTION: The outcomes of patients ventilated for longer than average are unclear, in part because of the lack of an accepted definition of prolonged mechanical ventilation (PMV). To better understand the implications of PMV provision, we compared one-year health outcomes between two common definitions of PMV as well as between PMV patients and those ventilated for shorter periods of time. METHODS: We conducted a secondary analysis of prospectively collected data from medical and surgical intensive care units at an academic tertiary care medical center. The study included 817 critically ill patients ventilated for > or = 48 hours, 267 (33%) of whom received PMV based on receipt of a tracheostomy and ventilation for > or = 96 hours. A total of 114 (14%) patients met the alternate definition of PMV by being ventilated for > or = 21 days. Survival, functional status, and costs were measured at baseline and at 2, 6, and 12 months after discharge. Of one-year survivors, 71 (17%) were lost to follow up. RESULTS: PMV patients ventilated for > or = 21 days had greater costs ($140,409 versus $143,389) and higher one-year mortality (58% versus 48%) than did PMV patients with tracheostomies who were ventilated for > or = 96 hours. The majority of PMV deaths (58%) occurred after hospital discharge whereas 67% of PMV patients aged 65 years or older had died by one year. At one year PMV patients on average had limitations in two basic and five instrumental elements of functional status that exceeded both their pre-admission status and the one-year disability of those ventilated for < 96 hours. Costs per one-year survivor were $423,596, $266,105, and $165,075 for patients ventilated > or = 21 days, > or = 96 hours with a tracheostomy, and < 96 hours, respectively. CONCLUSION: Contrasting definitions of PMV capture significantly different patient populations, with > or = 21 days of ventilation specifying the most resource-intensive recipients of critical care. PMV patients, particularly the elderly, suffer from a significant burden of costly, chronic critical illness and are at high risk for death throughout the first year after intensive care.

Duke Scholars

Published In

Crit Care

DOI

EISSN

1466-609X

Publication Date

2007

Volume

11

Issue

1

Start / End Page

R9

Location

England

Related Subject Headings

  • Tracheostomy
  • Time Factors
  • Survival Analysis
  • Respiration, Artificial
  • Quality of Life
  • Prospective Studies
  • Outcome Assessment, Health Care
  • Middle Aged
  • Intensive Care Units
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Cox, C. E., Carson, S. S., Lindquist, J. H., Olsen, M. K., Govert, J. A., Chelluri, L., & Quality of Life After Mechanical Ventilation in the Aged (QOL-MV) Investigators, . (2007). Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study. Crit Care, 11(1), R9. https://doi.org/10.1186/cc5667
Cox, Christopher E., Shannon S. Carson, Jennifer H. Lindquist, Maren K. Olsen, Joseph A. Govert, Lakshmipathi Chelluri, and Lakshmipathi Quality of Life After Mechanical Ventilation in the Aged (QOL-MV) Investigators. “Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study.Crit Care 11, no. 1 (2007): R9. https://doi.org/10.1186/cc5667.
Cox CE, Carson SS, Lindquist JH, Olsen MK, Govert JA, Chelluri L, et al. Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study. Crit Care. 2007;11(1):R9.
Cox, Christopher E., et al. “Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study.Crit Care, vol. 11, no. 1, 2007, p. R9. Pubmed, doi:10.1186/cc5667.
Cox CE, Carson SS, Lindquist JH, Olsen MK, Govert JA, Chelluri L, Quality of Life After Mechanical Ventilation in the Aged (QOL-MV) Investigators. Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study. Crit Care. 2007;11(1):R9.

Published In

Crit Care

DOI

EISSN

1466-609X

Publication Date

2007

Volume

11

Issue

1

Start / End Page

R9

Location

England

Related Subject Headings

  • Tracheostomy
  • Time Factors
  • Survival Analysis
  • Respiration, Artificial
  • Quality of Life
  • Prospective Studies
  • Outcome Assessment, Health Care
  • Middle Aged
  • Intensive Care Units
  • Humans