Mechanical ventilation increases mortality risk after ICU discharge

DENVER — Patients who underwent at least 1 week of mechanical ventilation had an increased risk for mortality and functional impairment 1 year after follow-up, according to study results presented at the American Thoracic Society International Conference.

“The RECOVER Program and its first phase Towards RECOVER shows that a diverse group of critically ill medical and surgical patients may be risk stratified into groups based on the [Functional Independence Measure (FIM)] at 7 days and by using patient age and ICU length of stay in those who have received mechanical ventilation for 1 or more weeks,” Margaret S. Herridge, MD, MPH, associate professor of medicine at the University of Toronto, told Healio.com/Pulmonology. “There is important functional disability across risk groups, but the most compromised outcomes are in those patients over age 66 who have been in the ICU for 2 or more weeks.”

Herridge and colleagues conducted a prospective, multicenter cohort study of 391 patients who survived at least 1 week or more of mechanical ventilation to assess outcomes up to 2 years after ICU to inform risk stratification for disability and rehabilitation for patients and caregivers.

Median ventilation time was 16 days, mean length of stay in the ICU was 22 days, and mean length of stay in the hospital was 29 days.

The researchers assessed patients with FIM, an indicator of disability level, and they also measured physical capacity, neuropsychological status, quality of life, health care utilization and mortality.

Forty percent of patients aged 46 to 66 years with an ICU stay of 14 days or longer died within the first year of follow-up. Twenty-nine percent required ICU readmittance.

“All critically ill patients, on average, have some degree of functional disability after 1 week in the ICU and may not return to baseline function even by 1 year,” Herridge said. “It may be very important to educate the lay public, ICU stakeholders and public health leaders about the incurred disability in these patients and how this affects subsequent functional independence, ability to live at home, health care utilization and quality of life.” – by Ryan McDonald

Reference:

Herridge MS, et al. Abstract 68191. Presented at: American Thoracic Society International Conference; May 15-20, 2015; Denver.

Disclosure: Herridge reports no relevant financial disclosures.