Chronic Ventilation Prognosis Worsens With Age, Consciousness/Cognitive State

Mortality in patients requiring prolonged mechanical ventilation in a long-term acute care hospital (LTACH) is associated with older age and worse consciousness and cognitive state, according to findings published in the Journal of Intensive Care Medicine.

“While in-LTACH mortality was at a high 45.5% during the study period, only a small proportion of the patients of all ages were discharged to their home, to rehabilitation departments, or to departments of complex nursing care,” reported a research team from the Hebrew University of Jerusalem, Israel. “Others remained at LTACH or were referred to emergency rooms in acute care hospitals.”

The study looked at outcomes for 308 adults aged 40 years and older who were admitted to a chronic ventilator dependent unit in an LTACH in Jerusalem. At admission, 42.2% were in a vegetative state/minimally conscious state, 32.5% had severe cognitive impairment, 11% had mild-to-moderate cognitive impairment, 12.3% had no cognitive impairment, and 1.9% had intellectual disability/psychiatric disorder.

Lengths of stay were 34.6 ± 42.6 for patients younger than 60 years, 19.1 ± 22.3 for patients 60 years through 79 years, and 14.4 ± 19.3 for patients 80 years and older. Some 30.6% of the patients younger than 60 years died while at the LTACH, as did 41.1% of those 60 years through 79 years and 54.8% of those 80 years and older.

By consciousness and cognitive state, LTACH lengths of stay were 23.8 ± 30.7 for patients in a vegetative state/minimally conscious state, 15.1 ± 19.5 for patients with severe cognitive impairment, 10.0 ± 12.8 for patients with mild-to-moderate cognitive impairment, and 18.9 ± 21.9 for patients without cognitive impairment. While at the LTACH, 50.8% of patients in a vegetative state/minimally conscious state and 58% of patients with severe cognitive impairment died. Mortality was 26.5% for patients with mild-to-moderate cognitive impairment and 13.2% for patients without cognitive impairment.

“There is a need for discussion regarding end-of-life decisions from the initial decision to resuscitate/intubate patients to the long-term management of these patients,” researchers wrote.

Reference:
Stein D, Sviri S, Beil M, Stav I, Marcus EL. Prognosis of chronically ventilated patients in a long-term ventilation facility: association with age, consciousness and cognitive state. J Intensive Care Med. Published online March 29, 2022. doi:10.1177/08850666221088800