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A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Expectations and outcomes of prolonged mechanical ventilation
Christopher E Cox1, Tereza Martinu, Shailaja J Sathy
1Duke University, Durham, NC, USA. christopher.cox@duke.edu
Critical Care Medicine
|September 23, 2009
Summary
Patient outcomes on prolonged mechanical ventilation were worse than expected by surrogates and physicians. Improving communication and realistic expectation setting in mechanical ventilation decisions is crucial.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Medical Decision Making
Background:
- Prolonged mechanical ventilation (PMV) provision is increasing despite poor patient outcomes.
- Misunderstanding prognosis may explain the rise in PMV decisions.
Purpose of the Study:
- Compare decision-makers' expectations for long-term outcomes with observed outcomes in PMV.
- Characterize surrogate-physician interactions in PMV decision-making.
Main Methods:
- Prospective observational cohort study at an academic medical center.
- 126 patients receiving PMV were included.
- Expectations for 1-year survival, function, and quality of life were compared with observed outcomes.
Main Results:
- Only 9% of patients were alive and independent at 1 year.
- Most surrogates (71-93%) reported high expectations for patient outcomes.
- Physicians reported significantly lower expectations (4-43%), with poor concordance with surrogates.
Conclusions:
- Observed 1-year outcomes for PMV patients were worse than expected by both surrogates and physicians.
- Deficiencies in prognostication, surrogate-physician discordance, and overly optimistic surrogate expectations were identified.
- Improving communication and expectation management in PMV decisions is essential.
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