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Long-term survival and health status after prolonged mechanical ventilation after cardiac surgery
M Engoren1, N F Buderer, A Zacharias
1Department of Anesthesiology, St. Vincent Mercy Medical Center, Toledo, OH, USA.
Objective:
To determine hospital mortality, weaning from mechanical ventilation, long-term survival, and functional health status in patients receiving > or =7 days of mechanical ventilation after cardiac surgery.
Design:
Retrospective chart review and prospective patient interviews.
Setting:
A university-affiliated, tertiary care medical center.
Patients:
A total of 124 patients that received > or =7 days of mechanical ventilation after cardiac surgery.
Interventions:
None.
Main Outcome Measures:
Hospital and long-term death, liberation from mechanical ventilation, and functional health status.
Measurements And Main Results:
A total of 19 (15%) patients died in hospital. Of the 105 survivors, 104 (99%) were completely weaned from mechanical ventilation. Patients who died in the hospital were more likely to have had a preoperative stroke or to have a new postoperative stroke, more likely to have postoperative renal failure, and less likely to have chronic obstructive pulmonary disease. Kaplan-Meier survival was 59% at 5 yrs and expected median survival was 6.2 yrs. Patients who died anytime after discharge were more likely to have preoperative renal dysfunction or stroke, took longer to be weaned from mechanical ventilation and to be discharged, and were more likely to have postoperative complications such as stroke or renal dysfunction. Also, they were more likely to be too debilitated to walk or eat. By multivariate analysis, admitting creatinine, aortic valve surgery, number of ventilator days, and discharged on tube feedings remained significant predictors of mortality. A total of 40 of 53 survivors were interviewed. Participants were similar to nonparticipants (p > .10 for all characteristics). A few (16%) had limitations of their activities of daily living (eating, dressing, bathing), and most had limitations of moderate activity (60%) and vigorous activity (94%). Only 36% could climb stairs or walk uphill without limitations, 54% could walk a block, and 41% had no limitations in house or job work. Half the participants had no body pain; 38% had moderate and 4% severe pain. Most (59%) described their general health as good to excellent. Only 10% said it was poor.
Conclusion:
Patients' chances of being liberated from mechanical ventilation are excellent. Their long-term survival and health status are good.