Medical and Economic Implications of Prolonged Mechanical Ventilation and Expedited Post–Acute Care

Christopher E. Cox; Shannon S. Carson

doi:10.1055/s-0032-1321985

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2012; 33(04): 357-361
DOI: 10.1055/s-0032-1321985

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Medical and Economic Implications of Prolonged Mechanical Ventilation and Expedited Post–Acute Care

Christopher E. Cox

¹Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina

,

Shannon S. Carson

²Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina

› Author Affiliations

Abstract

This article describes the increasingly common phenomenon of prolonged mechanical ventilation in the context of the transition between the acute care hospital and post–acute care. Prolonged mechanical ventilation or chronic critical illness is associated with hospital mortality in the range of 20 to 40%, with median hospital length of stay ranging from 14 to 60 days. Fewer than 10% of patients are discharged home, and most hospital survivors require institutionalized post–acute care in the form of long-term acute care, skilled nursing facilities, or inpatient rehabilitation. Acute hospital readmission is common. Because of prolonged functional disabilities and multiple underlying comorbid conditions, overall 1 year mortality for prolonged mechanical ventilation patients ranges from 50 to 60%. Survivors experience significant functional limitations. The prolonged institutional care and poor long-term outcomes of these patients bring into question the cost-effectiveness of prolonged mechanical ventilation after acute illness, especially for patients with poor long-term prognoses. New measures to facilitate assessments of long-term prognosis and improve communication with surrogate decision makers may reduce the amount of ineffective care for some patients requiring prolonged mechanical ventilation.

Keywords

prolonged mechanical ventilation - prognosis - health care costs

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References

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