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Management and prognosis of patients requiring prolonged mechanical ventilation

Author
MeiLan King Han, MD, MS
Section Editors
Polly E Parsons, MD
R Sean Morrison, MD
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Prolonged mechanical ventilation (PMV) is defined by the Centers for Medicare and Medicaid Services in the United States as greater than 21 days of mechanical ventilation for at least six hours per day [1], although many studies have used an alternative duration to define PMV. It is estimated that between 4 and 13 percent of mechanically ventilated patients require PMV [2,3], resulting in between 7250 and 11,400 patients undergoing PMV at any one time [2]. PMV is associated with increased health care cost, morbidity, and mortality [2,3].

Issues related to PMV are reviewed here, including predictors, weaning, complications, and outcomes. Issues related to the evaluation and management of patients who are difficult to wean from mechanical ventilation, as well as the selection of such patients for transfer to a long-term acute care facility where prolonged mechanical ventilation usually occurs, are discussed separately. (See "Management of the difficult-to-wean adult patient in the intensive care unit".)

PREDICTORS

Prediction of which patients will require prolonged mechanical ventilation (PMV) is discussed here, whereas prediction of successful liberation from mechanical ventilation is described elsewhere. (See "Weaning from mechanical ventilation: Readiness testing".)

There are no evidence-based predictors that can reliably identify patients who will require PMV. Studies have sought to identify such predictors, but their results are difficult to generalize because they examined varying durations of mechanical ventilation and specific patient populations. In addition, attempts to validate potential predictors have found poor sensitivity and specificity.

One of the few studies examining general medical and surgical intensive care unit (ICU) patients prospectively followed 5915 patients that required mechanical ventilation on the first day of their ICU admission. The relative contribution of various patient- and disease-related variables to the duration of mechanical ventilation was identified. The following variables were reported as being associated with an increased duration of mechanical ventilation, with their relative contribution shown in parentheses [4]:

                          

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Literature review current through: Nov 2016. | This topic last updated: Wed Apr 13 00:00:00 GMT 2016.
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