PURPOSE: To quantify comorbidities and to show their relationship to outcomes.
METHODS: All 323 patients admitted to this long term acute hospital from 1/1/03 to 12/31/04 requiring prolonged mechanical ventilation. All data were extracted from the medical records. Data collection continued until 12/31/05. Comorbidities were quantified using the cumulative illness rating scale (CIRS) which rates 14 organ systems from 0 (no impairments) to 4 (organ failure). All ratings were summed to create a Total Score. The Comorbidity Index was calculated by counting only those ratings of 3 and 4. Criteria for attempting weaning were based on pulmonary functions and overal clinical situation which have been generally accepted standards. Successful weaning was considered to be at least 4 consecutive weeks entirely free from ventilator support. Outcomes used were: whether or not weaning criteria were met; successful weaning or otherwise; deaths or other discharge dispositions. All statistical analyses were performed using analysis of variance (ANOVA).
RESULTS: The table shows the relationships between weaning criteria, weaning success, CIRS and discharge dispositions.
CONCLUSION: It is clear that as the burden of comorbidities increases then the likelihood of meeting weaning criteria and the likelihood of being successfully weaned goes down. Similarly greater burdens of comorbidities were associated with death or discharge to a higher more intense level of care i.e. an acute care general hospital. Lower burdens were associated with an increased likelihood of being successfully weaned as well as more discharges to a NF or home.
CLINICAL IMPLICATIONS: Consideration of comorbidities in patients requiring prolonged mechanical ventilation allows for more accurately predicting the likelihood of successful weaning and of ultimate discharge dispositions.
DISCLOSURE: J. Dermot Frengley, None.