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Outcomes After Long-term Mechanical Ventilation of Cancer Patients Outside of the Critical Care Setting FREE TO VIEW

Kelly Haviland, FNP-BC; kay see tan, PhD; Manju Pillai, MD; Diane Stover, MD; Robert Downey, MD
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Memorial Sloan Kettering Cancer Hospital, New York, NY

Chest. 2015;148(4_MeetingAbstracts):480A. doi:10.1378/chest.2215980
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SESSION TITLE: Process Improvement in Obstructive Lung Disease Education, Pneumonia Readmissions and Rapid Response Systems I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The likelihood of successful weaning from ventilatory support and the probability of long-term survival in chronically ill, mechanically ventilated cancer patients is unknown. Therefore, only incomplete information is available to guide prognostic therapeutic decisions by clinicians, the patient and their families. The Memorial Hospital (MH) Surgical Advance Care Unit (SACU) is a Nurse Practitioner led program of care that includes cancer patients with respiratory failure requiring long-term mechanical ventilation outside of a critical care setting. This retrospective study reviews weaning probability, length of time on the ventilator and overall survival in this population.

METHODS: An IRB approved retrospective review of MH patients between 2008-2011 requiring mechanical ventilation outside of a critical care setting was performed. The items recorded include approximately 60 data fields of patient characteristics, cancer specifics, comorbidities, treatments, and outcomes. Overall survival was determined using the Kaplan Meier approach. Time to weaning is analyzed using the cumulative incidence function approach in which death is considered a competing risk. We investigate potential prognostic factors to include in the prospective evaluation of the effectiveness of the planned weaning protocol.

RESULTS: Between 1/1/2008 and 12/31/11, 181 patients (84 female, 98 male) were mechanically ventilated outside of a critical care setting. Fifty-five of 68 patients (80%) were treated with weaning as a goal of care. The cumulative probability of patients being weaned by length of time since exit from the ICU on the ventilator was 37% by 14 days, 42% by 21 days, 47% by 30 days, 59% by 60 days and 62% by 90 days. While 101 patients (56%) survived to be discharged from Memorial Hospital, overall survival 2 years after the study period was only 18% (95% CI).

CONCLUSIONS: Data suggests that the goal to wean from mechnical ventilatory support in this cancer population can be achieved after prolonged periods of support, but that the likelihood of long-term overall survival is poor.

CLINICAL IMPLICATIONS: Continued data collection and analysis is needed to give prognostic information to guide clinical decision making. Based on this data, we have designed and implemented an evidence-based nurse practitioner led assessment and protocol, which will allow the collection of systematically recorded data. We expect the new protocol to increase probability of weaning and a decrease length of stay and cost of care for MH.

DISCLOSURE: The following authors have nothing to disclose: Kelly Haviland, kay see tan, Manju Pillai, Diane Stover, Robert Downey

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