Outcomes of prolonged intensive care and rehabilitation at a specialized multidisciplinary center in Sweden.
chronic critical illness
decannulation
multidisciplinary team
persistent critical illness
post-intensive care rehabilitation
prolonged intensive care
prolonged mechanical ventilation
weaning from mechanical ventilation
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
revised:
12
10
2021
received:
22
06
2021
accepted:
29
10
2021
pubmed:
16
11
2021
medline:
27
1
2022
entrez:
15
11
2021
Statut:
ppublish
Résumé
Specialized clinics may improve the outcome for patients with prolonged intensive care stays. Admission may depend on diagnosis, need of respiratory support and more. We report the results from a Swedish specialized center with a multidisciplinary team approach to continued intensive care and simultaneous rehabilitation regardless of patients' primary diagnosis or ventilator need. All patients admitted and discharged from 2015 to 2018 were included. Demographics, diagnoses, ventilatory support requirement, discharge destination and survival were retrieved from the center´s quality registry. A total of 181 patients, mean age 61 ± 16 years, 64% men, were analyzed. A neurological diagnosis was the cause for hospitalization in 46% of patients. Of the 55 patients admitted to the center for weaning from mechanical ventilation, 89% were successfully weaned within a median of 25 (interquartile range (IQR) 16-45) days. Decannulation was intended in 117 patients of which 90% were successful within a median of 25 (IQR 13-43) days. Readmission to intensive care was 4%. Most patients were discharged to their home or to rehabilitation clinics with a lower level of care. In-clinic mortality was 3%. Survival beyond 1 and 2 years after discharge was 79% and 70%, respectively. Patients with prolonged intensive care and complex medical needs treated at a specialized center in Sweden had weaning and decannulation rates comparable to or better than previously reported. Mortality was low, and most patients were discharged home or for further rehabilitation. This was achieved with a multidisciplinary team approach to continued intensive care and simultaneous rehabilitation.
Sections du résumé
BACKGROUND
BACKGROUND
Specialized clinics may improve the outcome for patients with prolonged intensive care stays. Admission may depend on diagnosis, need of respiratory support and more. We report the results from a Swedish specialized center with a multidisciplinary team approach to continued intensive care and simultaneous rehabilitation regardless of patients' primary diagnosis or ventilator need.
METHODS
METHODS
All patients admitted and discharged from 2015 to 2018 were included. Demographics, diagnoses, ventilatory support requirement, discharge destination and survival were retrieved from the center´s quality registry.
RESULTS
RESULTS
A total of 181 patients, mean age 61 ± 16 years, 64% men, were analyzed. A neurological diagnosis was the cause for hospitalization in 46% of patients. Of the 55 patients admitted to the center for weaning from mechanical ventilation, 89% were successfully weaned within a median of 25 (interquartile range (IQR) 16-45) days. Decannulation was intended in 117 patients of which 90% were successful within a median of 25 (IQR 13-43) days. Readmission to intensive care was 4%. Most patients were discharged to their home or to rehabilitation clinics with a lower level of care. In-clinic mortality was 3%. Survival beyond 1 and 2 years after discharge was 79% and 70%, respectively.
CONCLUSION
CONCLUSIONS
Patients with prolonged intensive care and complex medical needs treated at a specialized center in Sweden had weaning and decannulation rates comparable to or better than previously reported. Mortality was low, and most patients were discharged home or for further rehabilitation. This was achieved with a multidisciplinary team approach to continued intensive care and simultaneous rehabilitation.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
232-239Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
Références
Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med. 2010;182:446-454.
Kahn JM, Le T, Angus DC, et al. The epidemiology of chronic critical Illness in the United States. Crit Care Med. 2015;43:282-287.
Iwashyna TJ, Hodgson CL, Pilcher D, et al. Timing of onset and burden of persistent critical illness in Australia and New Zealand: a retrospective, population-based, observational study. Lancet Respir Med. 2016;4:566-573.
Bagshaw SM, Stelfox HT, Iwashyna TJ, Bellomo R, Zuege D, Wang X. Timing of onset of persistent critical illness: a multi-centre retrospective cohort study. Intensive Care Med. 2018;44:2134-2144.
Gardner AK, Ghita GL, Wang Z, et al. The development of chronic critical illness determines physical function, quality of life, and long-term survival among early survivors of sepsis in surgical intensive care units HHS Public Access. Crit Care Med. 2019;47:566-573.
Mira JC, Cuschieri J, Ozrazgat-Baslanti T, et al. The epidemiology of chronic critical illness after severe traumatic injury at two level one trauma centers HHS public access. Crit Care Med. 2017;45:1989-1996.
MacIntyre NR. Chronic critical illness: the growing challenge to health care. Respir Care. 2012;57:1021-1027.
Rak KJ, Ashcraft LE, Kuza CC, et al. Effective care practices in patients receiving prolonged mechanical ventilation: an ethnographic study. Am J Respir Crit Care Med. 2020;201:823-831.
Damuth E, Mitchell JA, Bartock JL, Roberts BW, Trzeciak S. Long-term survival of critically ill patients treated with prolonged mechanical ventilation: a systematic review and meta-analysis.Lancet. Respir Med. 2015;3:544-553.
Hannan LM, Tan S, Hopkinson K, et al. Inpatient and long-term outcomes of individuals admitted for weaning from mechanical ventilation at a specialized ventilation weaning unit. Respirology. 2013;18:154-160.
Bonnici DM, Sanctuary T, Warren A, et al. Prospective observational cohort study of patients with weaning failure admitted to a specialist weaning, rehabilitation and home mechanical ventilation centre. BMJ Open. 2016;6(3):e010025. 10.1136/bmjopen-2015-010025
Davies MG, Quinnell TG, Oscroft NS, Clutterbuck SP, Shneerson JM, Smith IE. Hospital outcomes and long-term survival after referral to a specialized weaning unit. Br J Anaesth. 2017;118:563-569.
Jubran A, Grant BJB, Duffner LA, et al. Long-term outcome after prolonged mechanical ventilation a long-term acute-care hospital study. Am J Respir Crit Care Med. 2019;199:1508-1516.
Sison SM, Sivakumar GK, Caufield-Noll C, Greenough WB, Oh ES, Galiatsatos P. Mortality outcomes of patients on chronic mechanical ventilation in different care settings: A Systematic review. Heliyon. 2021;7:e06230.
Jubran A, Grant BJB, Duffner LA, et al. Effect of pressure support vs unassisted breathing through a tracheostomy collar on weaning duration in patients requiring prolonged mechanical ventilation: A randomized trial. JAMA. 2013;309:671-677.
Nomellini V, Kaplan LJ, Sims CA, Caldwell CC. Chronic critical illness and persistent inflammation: what can we learn from the elderly, injured. Septic, and Malnourished?Shock. 2018;49:4-14.
White AC. Long-term mechanical ventilation: management strategies. Respir. Care. 2012;57:889-897.
Viglianti EM, Kramer R, Admon AJ, et al. Late organ failures in patients with prolonged intensive care unit stays. J Crit Care. 2018;46:55-57.
Hermans G, Van Aerde N, Meersseman P, et al. Five-year mortality and morbidity impact of prolonged versus brief ICU stay: a propensity score matched cohort study. Thorax. 2019;74(11):1037-1045. 10.1136/thoraxjnl-2018-213020
Jeffcote T, Foong M, Gold G, et al. Patient characteristics, ICU-specific supports, complications, and outcomes of persistent critical illness. J Crit Care. 2019;54:250-255.
Ghiani A, Paderewska J, Sainis A, Crispin A, Walcher S, Neurohr C. Variables predicting weaning outcome in prolonged mechanically ventilated tracheotomized patients: a retrospective study. J Intensive Care. 2020;8:19. 10.1186/s40560-020-00437-4.
Rosa RG, Falavigna M, Robinson CC, et al. Early and late mortality following discharge from the ICU: a multicenter prospective cohort study. Crit Care Med. 2020;48:64-72.
Sansone GR, Frengley JD, Vecchione JJ, Manogaram MG, Kaner RJ. Relationship of the duration of ventilator support to successful weaning and other clinical outcomes in 437 prolonged mechanical ventilation Patients. J Intensive Care Med. 2017;32:283-291.