Frailty tied to longer mechanical ventilation, identifies those less likely to be liberated

Frailty score was associated with longer duration of mechanical ventilation and aided in identifying patients less likely to be liberated, according to data published in the Annals of the American Thoracic Society.

“The relationship between frailty and invasive mechanical ventilation is complex, as invasive mechanical ventilation for patients with frailty may be preferentially avoided by patients, their family or clinicians, while the vulnerability to illness paradoxically may increase the requirement for organ support and resource use,” Shuji Okahara, PhD, researcher in the department of epidemiology and preventive medicine in the Australian and New Zealand Intensive Care Research Centre at Monash University in Melbourne, Australia, and colleagues wrote. “Therefore, it is unclear if frailty is independently associated with the duration of mechanical ventilation.”

Researchers conducted a retrospective, population-based, cohort study that included 59,319 patients who received invasive mechanical ventilation from 2017 to 2020, identified using data from the Australian and New Zealand Intensive Care Society Adult Patient Database. Researchers evaluated critically ill adults who received invasive mechanical ventilation within the first 24 hours of ICU admission.

Fourteen percent of patients were categorized as frail (mean age, 68 years; 54.5% men) and the remainder (86%) were not (mean age, 58.5 years; 66.7% men).

Those with frailty had a longer duration of mechanical ventilation compared with patients without frailty (27 hours vs. 16 hours; P < .001). Mechanical ventilation duration increased as a patient’s frailty score increased, according to the results.

In addition, those with frailty had longer ICU and hospital stays with higher mortality rates compared with those without frailty.

Frailty was also significantly associated with reduced likelihood of liberation from invasive mechanical ventilation after adjustment for relevant covariates (HR = 0.57; 95% CI, 0.51-0.64; P < .001).

These findings suggest that frailty may prolong the duration of mechanical ventilation use among survivors and the relationship was notably strong among younger patients, the researchers reported.

“These findings provide new insights into the prognosis for patients with different frailty degrees receiving invasive mechanical ventilation,” the researchers wrote. “The Clinical Frailty Scale offers important information to identify high-risk patients requiring longer invasive mechanical ventilation, which should be measured on patient admission and considered in ventilator weaning assessment in ICU.”