PURPOSE: To evaluate outcomes in 216 patients who had a primary cardiac or pulmonary reason for prolonged mechanical ventilation.
METHODS: 323 patients were admitted to the long term ventilator support units within this long term acute hospital from 1/1/03 to 12/31/04. Of these patients 216 (67%) had a primary cardiopulmonary diagnosis. The 216 patients were further divided into 3 groups: P pulmonary (e.g. pneumonia); C cardiac (e.g. myocardial infarction); or B both (e.g. CHF and pneumonia). Data extracted from the medical records included age, gender, days on ventilator before admission, weaning success (> 4 weeks free from any ventilator support), primary diagnoses requiring ventilator support, discharge disposition and death and Cumulative Illness Rating Scale (CIRS) for comorbidities. This scale separately rates 14 organ systems from 0 (no impairment) to 4 (organ failure). Total Score = sum of all ratings. Comorbidity Index = count of ratings 3 and 4. Statistical methods: analysis of variance (ANOVA) for age, days on ventilator and CIRS scores; Chi-square test for gender, success in weaning and discharge disposition.
RESULTS: The table shows the findings in these 216 patients.
CONCLUSION: Impaired cardiac or pulmonary function or dual impairments requiring prolonged mechanical ventilation appear to have no effect on clinical outcomes. There were no differences between the diagnostic groups in the proportion of patients successfully weaned, the discharge dispositions nor in the comorbidities. The number of women and the ages were greater in the cardiac and both groups than in the pulmonary perhaps reflecting the general distribution of gender by age within the hospital.
CLINICAL IMPLICATIONS: Impairments in pulmonary or cardiac systems which require prolonged mechanical ventilation do not differ in outcomes from each other or when there are impairments in both. There would appear to be no clinical reason for separating a cardiopulmonary group into its component parts.
DISCLOSURE: Giorgio Sansone, None.