SESSION TITLE: Respiratory Support Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: About 10% of patients initiated on invasive mechanical ventilation require prolonged respiratory support. Older studies indicate a significant hospital (20-48%) and 1 year (48-78%) mortality in this population. We report patient characteristics associated with 1-year mortality.
METHODS: We retrospectively collected data on 184 consecutive mechanically ventilated patients admitted to an LTACH for ventilator management from 2011 to 2012. Successful weaning from the ventilator was defined as freedom from invasive or non-invasive mechanical ventilatory assistance for 5 days. One year mortality was determined by interrogating the SSDI database (http://www.genealogybank.com/gbnk/ssdi). Two-sample t tests and Wilcoxon Two-sample tests were used to compare two groups for continuous variables. Chi-square test or Fisher’s exact test were used for categorical variables (p < 0.05 indicated a statistical significance).
RESULTS: One year overall mortality was 34.2% (63 of 184) with an LTACH mortality of 14.7% (27 of 184). Variables associated with 1 year mortality were: older age (60.7 years [+/-16.0] vs 68.5 years [+/-14.3]p= 0.0002), increased length of stay (38.2days [+/- 32.4] vs 28.9days [+/-16.8]p=0.0227), a diagnosis of CKD (stage 3 or higher)(33.3% VS 19% p=0.0306), a history of CHF (38.1% VS 17.4% p=0.0019) , a history of COPD (46% VS 24.8% p=0.0034), hemodialysis while at LTACH (15% vs 5.1% p=0.0256), acute renal failure (> AKIN II) (47.6% vs 27.3% p=0.0058), a new onset stroke or intracranial hemorrhage(11.1% vs 3.3% p=0.0482), new onset myocardial infarction (19% vs 7.4% p=0.0188), and inability to wean from mechanical ventilation(54% vs 9.2% p<0.0001), Failure to wean increased the odds of dying more than 10 fold at 1 year (OR 11.62 , 5.25-25.69 p<0.0001).
CONCLUSIONS: We report a lower 1 year mortality rate compared with historic data. Increased age, COPD, renal failure, MI, and CHF were associated with increased mortality. Failure to wean from mechanical ventilation increased the odds of 1 year mortality by more than 10 fold.
CLINICAL IMPLICATIONS: Factoring in age and selected comorbidities can further stratify one year mortality risk in select critically ill patients.
DISCLOSURE: The following authors have nothing to disclose: Jennifer Dixon, Michael Martinez, Frans van Wagenberg, Ying Fang, Cecilia Benz, Alejandro C Arroliga, Shekhar Ghamande, David Ciceri
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