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Survival in Patients Receiving Prolonged Ventilation: Factors that Influence Outcome.

Mamary AJ, Kondapaneni S, Vance GB, Gaughan JP, Martin UJ, Criner GJ - Clin Med Insights Circ Respir Pulm Med (2011)

Bottom Line: It is expensive and associated with significant morbidity and mortality.Our objective is to comprehensively characterize patients admitted to a Ventilator Rehabilitation Unit (VRU) for weaning and identify characteristics associated with survival. 182 consecutive patients over 3.5 years admitted to Temple University Hospital (TUH) VRU were characterized.Conversely, higher VRU admission hemoglobin was associated with better long term survival (OR 0.57-0.90; P = 0.0006).

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.

ABSTRACT

Background: Prolonged mechanical ventilation is increasingly common. It is expensive and associated with significant morbidity and mortality. Our objective is to comprehensively characterize patients admitted to a Ventilator Rehabilitation Unit (VRU) for weaning and identify characteristics associated with survival.

Methods: 182 consecutive patients over 3.5 years admitted to Temple University Hospital (TUH) VRU were characterized. Data were derived from comprehensive chart review and a prospectively collected computerized database. Survival was determined by hospital records and social security death index and mailed questionnaires.

Results: Upon admission to the VRU, patients were hypoalbuminemic (albumin 2.3 ± 0.6 g/dL), anemic (hemoglobin 9.6 ± 1.4 g/dL), with moderate severity of illness (APACHE II score 10.7 + 4.1), and multiple comorbidities (Charlson index 4.3 + 2.3). In-hospital mortality (19%) was related to a higher Charlson Index score (P = 0.006; OR 1.08-1.6), and APACHE II score (P = 0.016; OR 1.03-1.29). In-hospital mortality was inversely related to admission albumin levels (P = 0.023; OR 0.17-0.9). The presence of COPD as a comorbid illness or primary determinant of respiratory failure and higher VRU admission APACHE II score predicted higher long-term mortality. Conversely, higher VRU admission hemoglobin was associated with better long term survival (OR 0.57-0.90; P = 0.0006).

Conclusion: Patients receiving prolonged ventilation are hypoalbuminemic, anemic, have moderate severity of illness, and multiple comorbidities. Survival relates to these factors and the underlying illness precipitating respiratory failure, especially COPD.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier survival curve by primary cause for respiratory failure. Although not statistically significant, patients with trauma and neurological cause for respiratory failure showed a trend towards better survival than patients with chronic conditions (eg, COPD, morbid obesity).
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f4-ccrpm-2011-017: Kaplan-Meier survival curve by primary cause for respiratory failure. Although not statistically significant, patients with trauma and neurological cause for respiratory failure showed a trend towards better survival than patients with chronic conditions (eg, COPD, morbid obesity).

Mentions: We demonstrated a statistically significant out-of-hospital survival difference between patients with neurological respiratory failure and obesity related respiratory failure (neuro < obesity, P = 0.05; Fig. 4). The neuro group included patients with acute catastrophic illness, such as stroke or Guillain-Barre syndrome, with a subsequent recovery of some or all functions, whereas the morbidly obese (with an average BMI of 56.4 kg/m2) with hypoventilation syndrome and right sided heart failure had morbid chronic complications secondary to their weight such as diabetes mellitus, supraventricular arrhythmia, venous thrombosis, pneumonia and difficulty using non-invasive positive pressure ventilation Non-significant visual trends toward survival differences between neuro and. COPD and neuro and CHF/CAD invoke the limitation of small patient numbers.


Survival in Patients Receiving Prolonged Ventilation: Factors that Influence Outcome.

Mamary AJ, Kondapaneni S, Vance GB, Gaughan JP, Martin UJ, Criner GJ - Clin Med Insights Circ Respir Pulm Med (2011)

Kaplan-Meier survival curve by primary cause for respiratory failure. Although not statistically significant, patients with trauma and neurological cause for respiratory failure showed a trend towards better survival than patients with chronic conditions (eg, COPD, morbid obesity).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3091409&req=5

f4-ccrpm-2011-017: Kaplan-Meier survival curve by primary cause for respiratory failure. Although not statistically significant, patients with trauma and neurological cause for respiratory failure showed a trend towards better survival than patients with chronic conditions (eg, COPD, morbid obesity).
Mentions: We demonstrated a statistically significant out-of-hospital survival difference between patients with neurological respiratory failure and obesity related respiratory failure (neuro < obesity, P = 0.05; Fig. 4). The neuro group included patients with acute catastrophic illness, such as stroke or Guillain-Barre syndrome, with a subsequent recovery of some or all functions, whereas the morbidly obese (with an average BMI of 56.4 kg/m2) with hypoventilation syndrome and right sided heart failure had morbid chronic complications secondary to their weight such as diabetes mellitus, supraventricular arrhythmia, venous thrombosis, pneumonia and difficulty using non-invasive positive pressure ventilation Non-significant visual trends toward survival differences between neuro and. COPD and neuro and CHF/CAD invoke the limitation of small patient numbers.

Bottom Line: It is expensive and associated with significant morbidity and mortality.Our objective is to comprehensively characterize patients admitted to a Ventilator Rehabilitation Unit (VRU) for weaning and identify characteristics associated with survival. 182 consecutive patients over 3.5 years admitted to Temple University Hospital (TUH) VRU were characterized.Conversely, higher VRU admission hemoglobin was associated with better long term survival (OR 0.57-0.90; P = 0.0006).

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.

ABSTRACT

Background: Prolonged mechanical ventilation is increasingly common. It is expensive and associated with significant morbidity and mortality. Our objective is to comprehensively characterize patients admitted to a Ventilator Rehabilitation Unit (VRU) for weaning and identify characteristics associated with survival.

Methods: 182 consecutive patients over 3.5 years admitted to Temple University Hospital (TUH) VRU were characterized. Data were derived from comprehensive chart review and a prospectively collected computerized database. Survival was determined by hospital records and social security death index and mailed questionnaires.

Results: Upon admission to the VRU, patients were hypoalbuminemic (albumin 2.3 ± 0.6 g/dL), anemic (hemoglobin 9.6 ± 1.4 g/dL), with moderate severity of illness (APACHE II score 10.7 + 4.1), and multiple comorbidities (Charlson index 4.3 + 2.3). In-hospital mortality (19%) was related to a higher Charlson Index score (P = 0.006; OR 1.08-1.6), and APACHE II score (P = 0.016; OR 1.03-1.29). In-hospital mortality was inversely related to admission albumin levels (P = 0.023; OR 0.17-0.9). The presence of COPD as a comorbid illness or primary determinant of respiratory failure and higher VRU admission APACHE II score predicted higher long-term mortality. Conversely, higher VRU admission hemoglobin was associated with better long term survival (OR 0.57-0.90; P = 0.0006).

Conclusion: Patients receiving prolonged ventilation are hypoalbuminemic, anemic, have moderate severity of illness, and multiple comorbidities. Survival relates to these factors and the underlying illness precipitating respiratory failure, especially COPD.

No MeSH data available.


Related in: MedlinePlus