PMID- 35350916
OWN - NLM
STAT- MEDLINE
DCOM- 20221110
LR  - 20221116
IS  - 1525-1489 (Electronic)
IS  - 0885-0666 (Print)
IS  - 0885-0666 (Linking)
VI  - 37
IP  - 12
DP  - 2022 Dec
TI  - Prognosis of Chronically Ventilated Patients in a Long-Term Ventilation Facility: 
      Association with Age, Consciousness and Cognitive State.
PG  - 1587-1597
LID - 10.1177/08850666221088800 [doi]
AB  - Background: The number of adults requiring prolonged mechanical ventilation (PMV) 
      including those with cognitive impairment or disorders of consciousness is 
      escalating. We aimed to compare in a long-term acute care hospital (LTACH) 
      mortality and length of stay (LOS) among three age groups (40-59y, 60-79y, >/=80y) 
      of hospitalized PMV patients, and according to consciousness and cognitive state 
      at admission. Methods: We obtained data from the health records of 308 adults 
      aged >/=40 years requiring PMV hospitalized at a Chronic Ventilator Dependent Unit 
      in a LTACH between 01/01/2015 to 06/30/2019 and followed-up until discharge or 
      death or until 12/31/2019. Results: At admission to LTACH, 42.2% of PMV patients 
      were in a vegetative state/ minimally conscious state (VS/MCS); 32.5% were 
      severely cognitively impaired, 11.0% were mildly to moderately cognitively 
      impaired, 12.3% had no cognitive impairment, and 1.9% had intellectual 
      disability/psychiatric disorder. In-LTACH LOS (months) decreased from 34.6 +/- 42.6 
      at age 40-59y, 19.1 +/- 22.3 at 60-79y to 14.4 +/- 19.3 at age >/=80y (p = .006). 
      In-LTACH mortality was 30.6% for 40-59y, 41.1% for 60-79y and 54.8% for age >/=80y. 
      In-LTACH LOS (months) was 23.8 +/- 30.7 for VS/MCS, 15.1 +/- 19.5 for the severely 
      cognitively impaired, 10.0 +/- 12.8 for mild to moderate cognitive impairment and 
      18.9 +/- 21.9 for those without cognitive impairment (p = .02). In-LTACH mortality 
      was 50.8% for VS/MCS, 58.0% for the severely cognitively impaired, 26.5% for mild 
      to moderate cognitive impairment and 13.2% for those without cognitive impairment 
      (p < .001). Conclusion: In this population requiring PMV, mortality and in-LTACH 
      LOS worsened with age. In-LTACH LOS was longest for VS/MCS patients, who had a 
      mean survival of about two years, followed by those without cognitive impairment 
      and then those with severe cognitive impairment. Mortality was associated with 
      worse consciousness and cognitive state. These findings highlight the importance 
      of discussing end-of-life decisions with patients and family members regarding 
      resuscitation/intubation and the long-term management of these patients.
FAU - Stein, David
AU  - Stein D
AUID- ORCID: 0000-0001-8708-876X
AD  - Medical Intensive Care Unit, 58884Hadassah Medical Center and Faculty of 
      Medicine, Hebrew University of Jerusalem, Israel.
FAU - Sviri, Sigal
AU  - Sviri S
AD  - Medical Intensive Care Unit, 58884Hadassah Medical Center and Faculty of 
      Medicine, Hebrew University of Jerusalem, Israel.
FAU - Beil, Michael
AU  - Beil M
AD  - Medical Intensive Care Unit, 58884Hadassah Medical Center and Faculty of 
      Medicine, Hebrew University of Jerusalem, Israel.
FAU - Stav, Ilana
AU  - Stav I
AD  - Medical Intensive Care Unit, 58884Hadassah Medical Center and Faculty of 
      Medicine, Hebrew University of Jerusalem, Israel.
FAU - Marcus, Esther-Lee
AU  - Marcus EL
AD  - Chronic Ventilator-Dependent Division, 26733Herzog Medical Center and Faculty of 
      Medicine, Hebrew University of Jerusalem, Israel.
LA  - eng
PT  - Journal Article
DEP - 20220329
PL  - United States
TA  - J Intensive Care Med
JT  - Journal of intensive care medicine
JID - 8610344
SB  - IM
MH  - Adult
MH  - Humans
MH  - Middle Aged
MH  - *Respiration, Artificial
MH  - *Consciousness
MH  - Retrospective Studies
MH  - Ventilators, Mechanical
MH  - Prognosis
PMC - PMC9647314
OTO - NOTNLM
OT  - age
OT  - cognitive impairment
OT  - disorders of consciousness
OT  - long-term ventilation facility
OT  - outcome
OT  - prognosis
OT  - prolonged mechanical ventilation
COIS- The author(s) declared no potential conflicts of interest with respect to the 
      research, authorship, and/or publication of this article.
EDAT- 2022/03/31 06:00
MHDA- 2022/11/11 06:00
PMCR- 2022/11/10
CRDT- 2022/03/30 05:36
PHST- 2022/03/31 06:00 [pubmed]
PHST- 2022/11/11 06:00 [medline]
PHST- 2022/03/30 05:36 [entrez]
PHST- 2022/11/10 00:00 [pmc-release]
AID - 10.1177_08850666221088800 [pii]
AID - 10.1177/08850666221088800 [doi]
PST - ppublish
SO  - J Intensive Care Med. 2022 Dec;37(12):1587-1597. doi: 10.1177/08850666221088800. 
      Epub 2022 Mar 29.