2-month mortality and functional status of critically ill adult patients receiving prolonged mechanical ventilation.

STUDY
OBJECTIVES: To describe the 2-month mortality and functional status of adult patients receiving prolonged (at least 48 h) mechanical ventilation (MV), and to identify patient characteristics that are associated with 2-month mortality.
DESIGN: Prospective cohort study.
SETTING: Four ICUs at a tertiary-care institution. PATIENTS: Eight hundred seventeen patients who received prolonged MV.
INTERVENTIONS: None. MEASUREMENTS AND
RESULTS: Median age, sex distribution, and median Charlson comorbidity score of the 817 patients were 65 years, 45.8% women, and 1, respectively. The median scores on Katz Activities of Daily Living, Instrumental Activities of Daily Living Deficits, and Medical Outcomes Study Short-Form 36 surveys before hospitalization were 0, 1, and 50, respectively. Median APACHE (acute physiology and chronic health evaluation) III score and probability of hospital death for the cohort were 64 and 0.31, respectively. Median duration of MV was 9 days. Two-month mortality was 43%. Independent predictors of mortality at 2 months were age, comorbidities, and prehospital functional status. The adjusted odds of dying within 2 months increased 34% for each decade increase in age. Functional status deteriorated at 2 months compared to functional status prior to hospitalization, and 35% of the survivors were at risk for clinical depression. Among the 2-month survivors for whom the need for a caregiver was assessed, 78% had a caregiver.
CONCLUSIONS: Older age, in addition to functional status and comorbidities, was associated with increased mortality at 2 months. Functional status of survivors declined at 2 months.