One-Year Functional Outcomes After Invasive Mechanical Ventilation for Older Adults With Preexisting Long-Term Care-Needs.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 05 2023
01 05 2023
Historique:
medline:
17
4
2023
pubmed:
28
2
2023
entrez:
27
2
2023
Statut:
ppublish
Résumé
To examine 1-year functional outcomes after invasive mechanical ventilation for adults greater than or equal to 65 years with preexisting long-term care-needs. We used medical and long-term care administrative databases. The database included data on functional and cognitive impairments that were assessed with the national standardized care-needs certification system and were categorized into seven care-needs levels based on the total daily estimated care minutes. Primary outcome was mortality and care-needs at 1 year after invasive mechanical ventilation. Outcome was stratified by preexisting care-needs at the time of invasive mechanical ventilation: no care-needs, support level 1-2 and care-needs level 1 (estimated care time 25-49 min), care-needs level 2-3 (50-89 min), and care-needs level 4-5 (≥90 min). A population-based cohort study in Tochigi Prefecture, one of 47 prefectures in Japan. Among people greater than or equal to 65 years old registered between June 2014 and February 2018, patients who received invasive mechanical ventilation were identified. None. Among 593,990 eligible people, 4,198 (0.7%) received invasive mechanical ventilation. The mean age was 81.2 years, and 55.5% were male. The 1-year mortality rates after invasive mechanical ventilation in patients with no care-needs, support level 1-2 and care-needs level 1, care-needs level 2-3, and care-needs level 4-5 at the time of invasive mechanical ventilation were 43.4%, 54.9%, 67.8%, and 74.1%, respectively. Similarly, those with worsened care-needs were 22.8%, 24.2%, 11.4%, and 1.9%, respectively. Among patients in preexisting care-needs levels 2-5 who received invasive mechanical ventilation, 76.0-79.2% died or had worsened care-needs within 1 year. These findings may aid shared decision-making among patients, their families, and heath care professionals on the appropriateness of starting invasive mechanical ventilation for people with poor functional and cognitive status at baseline.
Identifiants
pubmed: 36847518
doi: 10.1097/CCM.0000000000005822
pii: 00003246-202305000-00004
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
584-593Subventions
Organisme : NIA NIH HHS
ID : K76 AG064434
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Dr. Ouchi is supported by the National Institute on Aging (K76AG064434) and Cambia Health Foundation and received support for article research from the National Institutes of Health. Dr. Yasunaga’s institution received funding from the Ministry of Health, Labour, and Welfare, Japan. Drs. Yasunaga’s and Sasabuchi’s institutions received funding from the Ministry of Education, Culture, Sports, Science and Technology, Japan. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Fernando SM, McIsaac DI, Rochwerg B, et al.: Frailty and invasive mechanical ventilation: Association with outcomes, extubation failure, and tracheostomy. Intensive Care Med 2019; 45:1742–1752
Unroe M, Kahn JM, Carson SS, et al.: One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: A cohort study. Ann Intern Med 2010; 153:167–175
A controlled trial to improve care for seriously ill hospitalized patients: The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT principal investigators. JAMA 1995; 274:1591–1598
Richardson SS, Sullivan G, Hill A, et al.: Use of aggressive medical treatments near the end of life: Differences between patients with and without dementia. Health Serv Res 2007; 42:183–200
Boumendil A, Angus DC, Guitonneau AL, et al.: Variability of intensive care admission decisions for the very elderly. PLoS One 2012; 7:e34387
Guidet B, Leblanc G, Simon T, et al.: Effect of systematic intensive care unit triage on long-term mortality among critically ill elderly patients in France: A randomized clinical trial. JAMA 2017; 318:1450–1459
Heyland DK, Cook DJ, Rocker GM, et al.: Decision-making in the ICU: Perspectives of the substitute decision-maker. Intensive Care Med 2003; 29:75–82
Khandelwal N, Kross EK, Engelberg RA, et al.: Estimating the effect of palliative care interventions and advance care planning on ICU utilization: A systematic review. Crit Care Med 2015; 43:1102–1111
George NR, Kryworuchko J, Hunold KM, et al.: Shared decision making to support the provision of palliative and end-of-life care in the emergency department: A consensus statement and research agenda. Acad Emerg Med 2016; 23:1394–1402
Ouchi K, Jambaulikar GD, Hohmann S, et al.: Prognosis after emergency department intubation to inform shared decision-making. J Am Geriatr Soc 2018; 66:1377–1381
Bouza C, Martínez-Alés G, López-Cuadrado T: Recent trends of invasive mechanical ventilation in older adults: A nationwide population-based study. Age Ageing 2021; 50:1607–1615
Pisani MA, Redlich CA, McNicoll L, et al.: Short-term outcomes in older intensive care unit patients with dementia. Crit Care Med 2005; 33:1371–1376
Barnato AE, Albert SM, Angus DC, et al.: Disability among elderly survivors of mechanical ventilation. Am J Respir Crit Care Med 2011; 183:1037–1042
Lagu T, Zilberberg MD, Tjia J, et al.: Use of mechanical ventilation by patients with and without dementia, 2001 through 2011. JAMA Intern Med 2014; 174:999–1001
Teno JM, Gozalo P, Khandelwal N, et al.: Association of increasing use of mechanical ventilation among nursing home residents with advanced dementia and intensive care unit beds. JAMA Intern Med 2016; 176:1809–1816
Lagu T, Zilberberg MD, Tjia J, et al.: Dementia and outcomes of mechanical ventilation. J Am Geriatr Soc 2016; 64:e63–e66
Borjaille CZ, Hill AD, Pinto R, et al.: Rates of mechanical ventilation for patients with dementia in Ontario: A population-based cohort study. Anesth Analg 2019; 129:e122–e125
Bouza C, Martínez-Alés G, López-Cuadrado T: Effect of dementia on the incidence, short-term outcomes, and resource utilization of invasive mechanical ventilation in the elderly: A nationwide population-based study. Crit Care 2019; 23:291
Ikegami N, Yoo BK, Hashimoto H, et al.: Japanese universal health coverage: Evolution, achievements, and challenges. Lancet 2011; 378:1106–1115
Yasunaga H: Real world data in Japan: Chapter I: NDB. Ann Clin Epidemiol 2019; 1:28–30
Tamiya N, Noguchi H, Nishi A, et al.: Population ageing and wellbeing: Lessons from Japan’s long-term care insurance policy. Lancet 2011; 378:1183–1192
Iwagami M, Tamiya N: The long-term care insurance system in Japan: Past, present, and future. JMA J 2019; 2:67–69
Tsutsui T, Muramatsu N: Care-needs certification in the long-term care insurance system of Japan. J Am Geriatr Soc 2005; 53:522–527
Matsuda T, Iwagami M, Suzuki T, et al.: Correlation between the Barthel index and care need levels in the Japanese long-term care insurance system. Geriatr Gerontol Int 2019; 19:1186–1187
Lin HR, Otsubo T, Imanaka Y: The effects of dementia and long-term care services on the deterioration of care-needs levels of the elderly in Japan. Med (Baltim) 2015; 94:e525
Lin HR, Otsubo T, Imanaka Y: Survival analysis of increases in care needs associated with dementia and living alone among older long-term care service users in Japan. BMC Geriatr 2017; 17:182
Quan H, Li B, Couris CM, et al.: Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011; 173:676–682
French B, Shotwell MS: Regression models for ordinal outcomes. JAMA 2022; 328:772–773
Hammes BJ, Rooney BL, Gundrum JD: A comparative, retrospective, observational study of the prevalence, availability, and specificity of advance care plans in a county that implemented an advance care planning microsystem. J Am Geriatr Soc 2010; 58:1249–1255
Fried TR, Bradley EH, Towle VR, et al.: Understanding the treatment preferences of seriously ill patients. N Engl J Med 2002; 346:1061–1066
Hennessy D, Juzwishin K, Yergens D, et al.: Outcomes of elderly survivors of intensive care: A review of the literature. Chest 2005; 127:1764–1774