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Mechanical ventilation in medical and neurological diseases: 11 years of experience
U G Ludwigs1, S Baehrendtz, M Wanecek
1Department of Medicine I, Södersjukhuset, Stockholm, Sweden.
Abstract:
Mechanical ventilation (MV) is imperative in many forms of acute respiratory failure (ARF). The aim of this work was to review all episodes of MV in a Medical Intensive Care Unit (MICU) during the 11-year period 1976-1986. Four per cent (n = 1008) of 24,899 admissions to the MICU were treated with MV. The mean age of ventilator-treated patients was 53 +/- 18 years, and obviously it increased during the period of study. The average duration of MV was 4.7 d. MICU mortality, hospital mortality and 2-year mortality rates for patients subjected to MV were 33%, 38% and 46%, respectively. The mortality rate did not change during the study period. Cerebrovascular and malignant diseases carried the highest mortality rates, 75 and 79%, respectively, whereas mortality in patients ventilated because of drug overdose (n = 313) was only 2%. The results of this study confirm previously published findings concerning the outcome of MV, and we conclude that the effects of MV remain discouraging in medical and neurological patients. Improved quality of ventilator therapy and monitoring, as well as continued research directed at the causes of ARF, are equally important in reducing the mortality in ARF.
Insights
Mechanical ventilation (MV) for acute respiratory failure (ARF) shows consistently high mortality rates. Outcomes for medical and neurological patients remain discouraging, highlighting the need for improved therapy and research.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Respiratory Therapy
Background:
- Mechanical ventilation (MV) is a critical intervention for acute respiratory failure (ARF).
- Understanding long-term outcomes of MV is essential for improving patient care.
- Previous studies indicate variable outcomes for patients requiring MV.
Purpose of the Study:
- To review all episodes of MV in a Medical Intensive Care Unit (MICU) over an 11-year period (1976-1986).
- To analyze mortality rates associated with MV in ARF patients.
- To identify factors influencing mortality in patients undergoing MV.
Main Methods:
- Retrospective review of 1008 patients treated with MV out of 24,899 MICU admissions.
- Analysis of patient demographics, duration of MV, and mortality rates (MICU, hospital, 2-year).
- Stratification of mortality based on underlying diseases, including cerebrovascular, malignant, and drug overdose cases.
Main Results:
- MV was used in 4% of MICU admissions, with a mean patient age of 53 years.
- Average MV duration was 4.7 days, with no significant change in mortality rates over the study period.
- MICU, hospital, and 2-year mortality rates were 33%, 38%, and 46%, respectively.
- Mortality was highest for cerebrovascular (75%) and malignant diseases (79%), but low for drug overdose (2%).
Conclusions:
- The study confirms previously reported discouraging outcomes of MV in medical and neurological patients.
- Mortality rates associated with MV for ARF did not improve during the study period.
- Enhancing ventilator therapy quality, monitoring, and research into ARF causes are crucial for reducing mortality.