In a startling revelation based on a study of nearly 400 patients who had been mechanically ventilated, researchers have revealed that those who have been subjected to this form of ventilation are at greatly increased risk of functional impairment and mortality at one year following discharge from intensive care unit (ICU). The study was presented at the 2015 American Thoracic Society International Conference.
The study involving 391 patients who had undergone at least one week of mechanical ventilation assessed patients for Functional Independence Measure (FIM), an indicator of disability level, along with measures of physical capacity, neuropsychological status, quality of life, healthcare utilization, and mortality. FIM score at seven days post post-ICU discharge was associated with patient age and length of stay in the ICU.
Resaerchers revealed that the oldest patients with the longest ICU stays had the worst outcomes, with 40 per cent of those patients aged 46-66 years with an ICU length of stay of 14 days or more dying within the first year of follow-up, 29 per cent being readmitted to ICU, and most exhibiting severe impairments in daily activities, including bathing, dressing and climbing stairs. In contrast, patients younger than 42 years of age with an ICU length of stay of less than two weeks had the best functional outcomes.
The rate of hospital readmission was high for all patients, ranging from 36 per cent to 43 per cent for different age and length of stay patient groups. FIM score, Charlson score (a measure of comorbidities), and age independently predicted mortality at one year.
“A combination of FIM score at 7 days after ICU discharge, length of stay in the ICU, and patient age can be used to predict subsequent impairment in mechanically ventilated patients,” said lead author Margaret Herridge. MD, MPH. of the University of Toronto. “Earlier intervention based on these predictions may improve outcomes for these high-risk patients.”
