Shannon M Fernando1,2, Daniel I McIsaac3,4,5, Bram Rochwerg6,7, Sean M Bagshaw8, John Muscedere9, Laveena Munshi10,11, Niall D Ferguson10,12, Andrew J E Seely13,4,5,14, Deborah J Cook6,7, Chintan Dave15, Peter Tanuseputro4,5,16,17, Kwadwo Kyeremanteng13,5,17,18. 1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca. 2. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca. 3. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada. 4. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. 5. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 6. Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada. 7. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 8. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. 9. Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada. 10. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 11. Department of Medicine, Sinai Health System, Toronto, ON, Canada. 12. Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. 13. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 14. Department of Surgery, University of Ottawa, Ottawa, ON, Canada. 15. Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 16. Bruyere Research Institute, Ottawa, ON, Canada. 17. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 18. Institut du Savoir Montfort, Ottawa, ON, Canada.
Abstract
PURPOSE: Invasive mechanical ventilation is a common form of life support provided to critically ill patients. Frailty is an emerging prognostic factor for poor outcome in the Intensive Care Unit (ICU); however, its association with adverse outcomes following invasive mechanical ventilation is unknown. We sought to evaluate the association between frailty, defined by the Clinical Frailty Scale (CFS), and outcomes of ICU patients receiving invasive mechanical ventilation. METHODS: We performed a retrospective analysis (2011-2016) of a prospectively collected registry from two hospitals of consecutive ICU patients ≥ 18 years of age receiving invasive mechanical ventilation. CFS scores were based on recorded pre-admission function at the time of hospital admission. The primary outcome was hospital mortality. Secondary outcomes included discharge to long-term care, extubation failure at time of first liberation attempt, and tracheostomy. RESULTS: We included 8110 patients, and 2529 (31.2%) had frailty (CFS ≥ 5). Frailty was associated with increased odds of hospital death (adjusted odds ratio [aOR]: 1.24 [95% confidence interval [CI] 1.10-1.40) and discharge to long-term care (aOR 1.21 [95% CI 1.13-1.35]). As compared to patients without frailty, patients with frailty had increased odds of extubation failure (aOR 1.17 [95% CI 1.04-1.37]), hospital death following extubation failure (aOR 1.18 [95% CI 1.07-1.28]), tracheostomy (aOR 1.17 [95% CI 1.01-1.36]), and hospital death following tracheostomy (aOR 1.14 [95% CI 1.03-1.25]). CONCLUSIONS: The presence of frailty among patients receiving mechanical ventilation is associated with increased odds of hospital mortality, discharge to long-term care, extubation failure, and need for tracheostomy.
PURPOSE: Invasive mechanical ventilation is a common form of life support provided to critically illpatients. Frailty is an emerging prognostic factor for poor outcome in the Intensive Care Unit (ICU); however, its association with adverse outcomes following invasive mechanical ventilation is unknown. We sought to evaluate the association between frailty, defined by the Clinical Frailty Scale (CFS), and outcomes of ICU patients receiving invasive mechanical ventilation. METHODS: We performed a retrospective analysis (2011-2016) of a prospectively collected registry from two hospitals of consecutive ICU patients ≥ 18 years of age receiving invasive mechanical ventilation. CFS scores were based on recorded pre-admission function at the time of hospital admission. The primary outcome was hospital mortality. Secondary outcomes included discharge to long-term care, extubation failure at time of first liberation attempt, and tracheostomy. RESULTS: We included 8110 patients, and 2529 (31.2%) had frailty (CFS ≥ 5). Frailty was associated with increased odds of hospital death (adjusted odds ratio [aOR]: 1.24 [95% confidence interval [CI] 1.10-1.40) and discharge to long-term care (aOR 1.21 [95% CI 1.13-1.35]). As compared to patients without frailty, patients with frailty had increased odds of extubation failure (aOR 1.17 [95% CI 1.04-1.37]), hospital death following extubation failure (aOR 1.18 [95% CI 1.07-1.28]), tracheostomy (aOR 1.17 [95% CI 1.01-1.36]), and hospital death following tracheostomy (aOR 1.14 [95% CI 1.03-1.25]). CONCLUSIONS: The presence of frailty among patients receiving mechanical ventilation is associated with increased odds of hospital mortality, discharge to long-term care, extubation failure, and need for tracheostomy.
Authors: Christian Labenz; Wolfgang M Kremer; Jörn M Schattenberg; Marcus-Alexander Wörns; Gerrit Toenges; Arndt Weinmann; Peter R Galle; Martin F Sprinzl Journal: J Investig Med Date: 2020-07-07 Impact factor: 2.895
Authors: Shannon M Fernando; Rebecca Mathew; Benjamin Hibbert; Bram Rochwerg; Laveena Munshi; Allan J Walkey; Morten Hylander Møller; Trevor Simard; Pietro Di Santo; F Daniel Ramirez; Peter Tanuseputro; Kwadwo Kyeremanteng Journal: Crit Care Date: 2020-01-13 Impact factor: 9.097
Authors: Gemma F Spiers; Tafadzwa Patience Kunonga; Alex Hall; Fiona Beyer; Elisabeth Boulton; Stuart Parker; Peter Bower; Dawn Craig; Chris Todd; Barbara Hanratty Journal: BMJ Open Date: 2021-03-22 Impact factor: 2.692
Authors: Wolfgang M Kremer; Michael Nagel; Michael Reuter; Max Hilscher; Maurice Michel; Leonard Kaps; Joachim Labenz; Peter R Galle; Martin F Sprinzl; Marcus-Alexander Wörns; Christian Labenz Journal: Clin Transl Gastroenterol Date: 2020-07 Impact factor: 4.396