Clinical features and outcomes of prolonged mechanical ventilation: a single-center retrospective observational study

Isao Nagata,Masafumi Toh,Hiroyuki Yamada,Michiko Fujisawa,Tetsuhiro Takei,Junji Hatakeyama

doi:10.1186/s40981-019-0284-4

Abstract

BackgroundInformation on epidemiology of prolonged mechanical ventilation (PMV) patients in the acute care setting in Japan is totally lacking. We aimed to investigate clinical features, impact, and long-term outcomes of PMV patients.MethodsThis was a retrospective observational study conducted in a tertiary care hospital. Adult patients who were admitted to our intensive care unit (ICU) from April 2009 to March 2014 and required mechanical ventilation (MV) for ≥ 2 days were included. PMV was defined as having MV for ≥ 21 consecutive days.ResultsAmong 1282 MV patients, 93 (7.3%) required PMV, and median duration of MV was 37.0 days. Compared with the non-PMV patients, PMV patients had longer total ICU and high care unit (HCU) stay (34.0 vs. 7.0 days, p < 0.001), longer hospital stay (74.0 vs. 35.0 days, p < 0.001), and higher hospital mortality (54.8 vs. 21.4%, p < 0.001). In multivariable logistic regression analysis, emergency ICU admission and steroid use during MV were associated with PMV. The Kaplan–Meier curves for MV withdrawal and ICU/HCU discharge were almost identical. Among PMV patients, 52 (55.9%) died, 29 (31.2%) were successfully liberated from MV during hospitalization, and 12 (12.9%) still required MV at discharge.ConclusionIn this investigation, 7.3% of the patients with MV required PMV. Most PMV patients were liberated from MV during hospitalization, while occupying critical care beds for an extended period. A nationwide survey is required to further elucidate the overall picture of PMV patients and to discuss whether specialized weaning centers to treat PMV patients are required in Japan.

Highlights

Among patients admitted to the intensive care unit (ICU), 30–60% received mechanical ventilation (MV) [1,2,3,4]
Patients requiring prolonged mechanical ventilation (PMV) are transferred from ICUs in acute care hospitals to long-term acute care hospitals (LTACHs) or regional weaning centers (RWCs) in the early stage of PMV
Patients are initially treated in ICU or high care unit (HCU) by intensivists, and they are liberated from MV according to our weaning protocol which was based on the guidelines for weaning and discontinuing ventilatory support published in 2001 [18]

Summary

Introduction

Among patients admitted to the intensive care unit (ICU), 30–60% received mechanical ventilation (MV) [1,2,3,4]. Patients requiring PMV are transferred from ICUs in acute care hospitals to long-term acute care hospitals (LTACHs) or regional weaning centers (RWCs) in the early stage of PMV These facilities function as specialized post-ICU weaning centers, and in countries such as Japan lacking weaning centers, patients who require PMV may occupy ICU beds in acute care hospitals for an extended period, thereby affecting the fair allocation of critical care resources [2, 4, 12,13,14]. These patients place substantial loads on intensivists throughout the long period of the weaning trial. We aimed to investigate clinical features, impact, and long-term outcomes of PMV patients

Objectives

Methods

Results

Conclusion