Dynamic Changes in Prognosis with Elapsed Time on Ventilators among Mechanically Ventilated Patients

Area of Science:

• Critical Care Medicine
• Pulmonology
• Health Services Research

Background:

• Previous mechanical ventilation outcome studies used static timeframes, not reflecting dynamic patient and family needs for updated prognosis.
• Patients and families often seek prognosis information repeatedly after mechanical ventilation initiation.

Purpose of the Study:

• To describe dynamic changes in prognosis based on elapsed time on a ventilator for mechanically ventilated patients.
• To provide ventilator-day-specific prognosis information.

Main Methods:

• A cohort study using Taiwan's National Health Insurance database.
• Inclusion of adults receiving invasive mechanical ventilation for ≥2 consecutive days (March 2010–August 2011).
• Estimation of cumulative 90-day probabilities of weaning success and death for each ventilator day.

Main Results:

• 162,200 episodes of invasive mechanical ventilation were analyzed.
• Weaning success probability decreased unidirectionally with time on ventilation, notably in the first 2 months.
• Death probability initially increased then decreased after the 19th ventilator day.

Conclusions:

• This study offers ventilator-day-specific prognosis from a large, unselected cohort.
• Weaning success probability declines with increased time on mechanical ventilation, especially within the first two months.
• Tailored prognosis information based on age, sex, and ventilator days is provided.