Amal Jubran1,2,3, Brydon J B Grant4, Lisa A Duffner1,2,3, Eileen G Collins1,2,3,5, Dorothy M Lanuza6, Leslie A Hoffman7, Martin J Tobin1,2,3. 1. 1 Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois. 2. 2 Loyola University of Chicago Stritch School of Medicine, Maywood, Illinois. 3. 3 RML Specialty Hospital, Hinsdale, Illinois. 4. 4 University at Buffalo, Buffalo, New York. 5. 5 University of Illinois at Chicago, Chicago, Illinois. 6. 6 University of Wisconsin, Madison, Wisconsin; and. 7. 7 University of Pittsburgh, Pittsburgh, Pennsylvania.
Abstract
Rationale: Patients managed at a long-term acute-care hospital (LTACH) for weaning from prolonged mechanical ventilation are at risk for profound muscle weakness and disability. Objectives: To investigate effects of prolonged ventilation on survival, muscle function, and its impact on quality of life at 6 and 12 months after LTACH discharge. Methods: This was a prospective, longitudinal study conducted in 315 patients being weaned from prolonged ventilation at an LTACH. Measurements and Main Results: At discharge, 53.7% of patients were detached from the ventilator and 1-year survival was 66.9%. On enrollment, maximum inspiratory pressure (Pimax) was 41.3 (95% confidence interval, 39.4-43.2) cm H2O (53.1% predicted), whereas handgrip strength was 16.4 (95% confidence interval, 14.4-18.7) kPa (21.5% predicted). At discharge, Pimax did not change, whereas handgrip strength increased by 34.8% (P < 0.001). Between discharge and 6 months, handgrip strength increased 6.2 times more than did Pimax. Between discharge and 6 months, Katz activities-of-daily-living summary score improved by 64.4%; improvement in Katz summary score was related to improvement in handgrip strength (r = -0.51; P < 0.001). By 12 months, physical summary score and mental summary score of 36-item Short-Form Survey returned to preillness values. When asked, 84.7% of survivors indicated willingness to undergo mechanical ventilation again. Conclusions: Among patients receiving prolonged mechanical ventilation at an LTACH, 53.7% were detached from the ventilator at discharge and 1-year survival was 66.9%. Respiratory strength was well maintained, whereas peripheral strength was severely impaired throughout hospitalization. Six months after discharge, improvement in muscle function enabled patients to perform daily activities, and 84.7% indicated willingness to undergo mechanical ventilation again.
Rationale: Patients managed at a long-term acute-care hospital (LTACH) for weaning from prolonged mechanical ventilation are at risk for profound muscle weakness and disability. Objectives: To investigate effects of prolonged ventilation on survival, muscle function, and its impact on quality of life at 6 and 12 months after LTACH discharge. Methods: This was a prospective, longitudinal study conducted in 315 patients being weaned from prolonged ventilation at an LTACH. Measurements and Main Results: At discharge, 53.7% of patients were detached from the ventilator and 1-year survival was 66.9%. On enrollment, maximum inspiratory pressure (Pimax) was 41.3 (95% confidence interval, 39.4-43.2) cm H2O (53.1% predicted), whereas handgrip strength was 16.4 (95% confidence interval, 14.4-18.7) kPa (21.5% predicted). At discharge, Pimax did not change, whereas handgrip strength increased by 34.8% (P < 0.001). Between discharge and 6 months, handgrip strength increased 6.2 times more than did Pimax. Between discharge and 6 months, Katz activities-of-daily-living summary score improved by 64.4%; improvement in Katz summary score was related to improvement in handgrip strength (r = -0.51; P < 0.001). By 12 months, physical summary score and mental summary score of 36-item Short-Form Survey returned to preillness values. When asked, 84.7% of survivors indicated willingness to undergo mechanical ventilation again. Conclusions: Among patients receiving prolonged mechanical ventilation at an LTACH, 53.7% were detached from the ventilator at discharge and 1-year survival was 66.9%. Respiratory strength was well maintained, whereas peripheral strength was severely impaired throughout hospitalization. Six months after discharge, improvement in muscle function enabled patients to perform daily activities, and 84.7% indicated willingness to undergo mechanical ventilation again.
Authors: Shannon S Carson; Jeremy M Kahn; Catherine L Hough; Eric J Seeley; Douglas B White; Ivor S Douglas; Christopher E Cox; Ellen Caldwell; Shrikant I Bangdiwala; Joanne M Garrett; Gordon D Rubenfeld Journal: Crit Care Med Date: 2012-04 Impact factor: 7.598
Authors: Sanford Levine; Taitan Nguyen; Nyali Taylor; Michael E Friscia; Murat T Budak; Pamela Rothenberg; Jianliang Zhu; Rajeev Sachdeva; Seema Sonnad; Larry R Kaiser; Neal A Rubinstein; Scott K Powers; Joseph B Shrager Journal: N Engl J Med Date: 2008-03-27 Impact factor: 91.245
Authors: Jeneen M Gifford; Nadia Husain; Victor D Dinglas; Elizabeth Colantuoni; Dale M Needham Journal: Crit Care Med Date: 2010-03 Impact factor: 7.598
Authors: Luca M Bigatello; Henry Thomas Stelfox; Lorenzo Berra; Ulrich Schmidt; Elise M Gettings Journal: Crit Care Med Date: 2007-11 Impact factor: 7.598
Authors: Laura M Keohane; Matthew F Mart; E Wesley Ely; Pikki Lai; Audrey Cheng; Anil N Makam; David G Stevenson Journal: J Am Geriatr Soc Date: 2021-10-19 Impact factor: 5.562
Authors: Franco Laghi; Hameeda Shaikh; Stephen W Littleton; Daniel Morales; Amal Jubran; Martin J Tobin Journal: J Appl Physiol (1985) Date: 2020-07-16
Authors: Dagmar Giese; Jörg Blau; Walter Knüppel; Aggi Neumann-Schiebener; Andreas Günther; Christian Reinhardt; Wolfram Windisch; Stefan Andreas Journal: Dtsch Med Wochenschr Date: 2020-09-09 Impact factor: 0.628
Authors: Catherine L Auriemma; Stephanie P Taylor; Michael O Harhay; Katherine R Courtright; Scott D Halpern Journal: Am J Respir Crit Care Med Date: 2021-10-15 Impact factor: 30.528