There is limited information regarding the outcome and survival of institutionalized patients who present with acute respiratory failure. We investigated the inpatient outcome and one year mortality of nursing home patients intubated in an emergency department.
We performed a retrospective analysis of medical records of nursing home patients who presented to our Emergency Department with acute respiratory failure from 2000-03. Cause of acute respiratory failure, severity of illness, length of stay, hospital survival and cost of admission were noted. Multivariate analysis of admission patient characteristics was performed to determine which were associated with outcome. One-year mortality data were collected from hospital records and the Michigan Department of Vital Statistics. For hospital outcome analysis each admission was analyzed. One-year mortality analysis was performed per patient.
354 episodes of acute respiratory failure in 277 patients were studied. Overall hospital mortality was 48%. Mean hospital length of stay was 4.27 [± 6.051 standard deviation (SD)] days in patients who expired and 10.78 (± 6.107 SD) days for survivors. Mean total charges of admission were $30,032 for all patients. Fifteen clinical factors at presentation were significantly associated with hospital mortality. Most predictive were: presence of cardiopulmonary resuscitation (CPR) [89% mortality; odds ratio (OR) 8.397; p< 0.0001], vasopressor use in the ED (70% mortality; OR 2.586; p< 0.0001), history of cancer of any type (70% mortality; OR 2.543; p<0.005) and cardiovascular failure (65% mortality; OR 2.018; p<0.0001). For the 277 patients studied the one-year mortality was 87%.
The occurrence of acute respiratory failure in nursing home patients is associated with significant hospital mortality and charges. Less than 15% survive for one year after the intubation episode. Hospital mortality was especially pronounced in patients with a history of cancer, vasopressor use in the ED, who present in cardiovascular failure or who have undergone CPR.
End-of-life-care discussions in the nursing home population should include consideration of acute respiratory failure as a harbinger of death.
Jason Moore, None.