Prolonged Mechanical Ventilation in Critically Ill Patients

BACKGROUND: There is limited knowledge about long-term mortality, care pathways, and health-related quality of life (HrQoL) among patients in the ICU receiving prolonged mechanical ventilation (PMV). RESEARCH QUESTION: What are the long-term mortality, care pathways, and HrQoL of patients receiving invasive PMV, stratified by weaning success? STUDY DESIGN AND METHODS: We conducted a secondary analysis of patients from the cluster-randomized controlled Enhanced Recovery After Intensive Care trial who were treated in 2 ICU clusters and received invasive PMV (≥ 21 days via endotracheal tube/tracheostomy or ≥ 4 days via tracheostomy). Data on weaning success, mortality, care place transitions, readmissions, and HrQoL were collected for 6 months after ICU discharge. RESULTS: Of 90 patients receiving PMV in the ICU, 46% (41 of 90 patients) died (21 patients in the ICU and 20 patients within 6 months after ICU discharge). Of 69 patients discharged alive, 25% (17 of 69 patients) could not be weaned, whereas 75% (52 of 69 patients) were successfully weaned within 6 months. Patients experienced a median of 3 (Q1, Q3: 2, 5) care place transitions within 6 months, with more care place transitions among successfully weaned patients (median, 4 [Q1, Q3: 2, 5] vs 2 [1, 3], P = .004). The readmission rate among all patients was 46% within 6 months. One-half of the successfully weaned patients transitioned home, whereas unsuccessfully weaned patients mostly transitioned from weaning centers to nursing homes or died. Unsuccessfully weaned patients had fewer quality-adjusted life days within 6 months than successfully weaned patients (median, 0 [Q1, Q3: 0, 32.6] vs 73.1 [23.2, 135], P = .002). INTERPRETATION: Our results show that three-quarters of patients receiving PMV who were discharged alive were weaned, but their HrQoL was reduced. The decision to proceed with PMV should weigh in patient preferences for living with HrQoL limitations and patients' likelihood of weaning. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT03671447; URL: www. CLINICALTRIALS: gov.