Abstract
Background: The number of patients receiving prolonged mechanical ventilation (PMV) or maintenance dialysis (MD) is increasing worldwide. Identification of those with a short life expectancy is useful for early referral of palliative care.Objective: To determine the survival rate, life expectancy, and major prognostic factors in patients under both PMV and MD.Design: We extracted a 1:3.4 random sample of patients treated with mechanical ventilation (MV) from the National Health Insurance (NHI) Research Database of Taiwan from 2003 to 2007. Subjects who had undergone MD and received MV for longer than 21 days were enrolled.Setting/Subjects: There were 1035 patients who received both PMV and MD.Measurements: The survival rates and life expectancy were estimated. A multivariate proportional hazards model was constructed to validate the effects of different prognostic factors, including age, gender, hospital size, and major comorbidities.Results: The median length of survival of patients under both PMV and MD was 54 days. The three-month, six-month, and one-year survival rates were 40.8%, 24.1%, and 12.6%, respectively. The life expectancies of those older than 70 years were five months; those comorbid with cancer and septicemia were 112 and 90 days, respectively. After adjustments for covariates, we found following prognostic factors were statistically significant: gangrene, peritonitis, liver cirrhosis, cancer, septicemia, hydrocephalus, having device complications, and shock.Conclusions: More than 85% of patients receiving both PMV and MD died within one year. Communication and early referral for palliative care would be indicated for those comorbid with significant prognostic factors.
Highlights
There are studies reporting the poor prognosis of patients under prolonged mechanical ventilation (PMV),[9,21,22] to the best of our knowledge, we are among the first to explore the crucial estimates of detailed survival rates and life expectancies for patients receiving both PMV and maintenance dialysis (MD) based on a national database, as summarized in Tables 3 and 4
The prognosis of these patients were generally poor, as they usually suffered from additional comorbidities of diabetes mellitus (DM), HTN, urological cancer,[23] device complications,[24] and peritonitis.[25]
Our national sample showed that the life expectancy of patients receiving PMV but not MD would be less than two years, and only 34.4% of these patients could survive for more than one year, that is, nearly two of three patients would die within one year (Table 2)
Summary
PMV is defined as requiring more than 6 hours/day of MV for at least 21 consecutive days.[8] For patients who are unable to wean from MV within three weeks of intubation, the step would usually be for them to receive tracheostomy and be transferred to a specialized respiratory care unit for further trials of weaning or long-term care When making these medical decisions, the expected outcomes of patients. The number of patients receiving prolonged mechanical ventilation (PMV) or maintenance dialysis (MD) is increasing worldwide Identification of those with a short life expectancy is useful for early referral of palliative care. The life expectancies of those older than 70 years were five months; those comorbid with cancer and septicemia were 112 and 90 days, respectively. Communication and early referral for palliative care would be indicated for those comorbid with significant prognostic factors
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