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- Title
Prolonged Mechanical Ventilation in 540 Seriously Ill Older Adults: Effects of Increasing Age on Clinical Outcomes and Survival.
- Authors
Dermot Frengley, J.; Sansone, Giorgio R.; Shakya, Kunjan; Kaner, Robert J.
- Abstract
Objectives To investigate effects of older age, comorbidities, and physiological measures on outcomes of elderly adults requiring prolonged mechanical ventilation ( PMV). Design Retrospective cohort study. Setting Public long-term acute care hospital ( LTACH) with an active program for ventilator weaning from PMV. Participants Chronically seriously ill individuals with PMV aged 65 and older divided into six cohorts (65-69, 70-74, 75-79, 80-84, 85-89, ≥90) for comparative purposes (n = 540). Measurements Main outcomes were weaning criteria met, weaning success, discharge dispositions, and long-term survival. Other outcomes included weaning duration, LTACH days, discharge physical function, tracheostomy decannulation, and relapses to ventilator support. Weaning success was defined as 4 weeks or longer entirely free from mechanical ventilator support. Results The main finding from age cohort comparisons was that the likelihood of meeting weaning criteria ( P = .001) and subsequent successful weaning ( P = .002) decreased with age. Best predictors for weaning success in multivariable analysis were lower comorbidity burden ( P < .001) and less-severe illness ( P = .001). Other clinically important predictors were more-normal values in the respiratory physiology measures of rapid shallow breathing ( P = .001) and static compliance ( P = .003). Successful weaning was also associated with a 62% lower risk of death ( P < .001). Conclusion Although meeting weaning criteria and being successfully weaned decreased with increasing age, age was not the dominant factor in predicting outcomes. More importantly, individuals with PMV with better respiratory physiology and lower comorbidity burdens were more likely to be weaned and have longer survival, no matter their age.
- Subjects
PATIENTS; ANALYSIS of variance; ARTIFICIAL respiration; CHI-squared test; CONFIDENCE intervals; CRITICALLY ill; EPIDEMIOLOGY; LONGITUDINAL method; HEALTH outcome assessment; REGRESSION analysis; STATISTICS; SURVIVAL analysis (Biometry); MECHANICAL ventilators; DATA analysis; PROPORTIONAL hazards models; RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics; KAPLAN-Meier estimator; LOG-rank test; OLD age
- Publication
Journal of the American Geriatrics Society, 2014, Vol 62, Issue 1, p1
- ISSN
0002-8614
- Publication type
Article
- DOI
10.1111/jgs.12597