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Prognosis of mechanically ventilated patients
M A Papadakis1, K K Lee, W S Browner
1Department of Medicine, University of California, School of Medicine, San Francisco.
The Western Journal of Medicine
|December 1, 1993
Summary
Predictors of mortality in mechanically ventilated veterans were identified. High mortality rates were observed in older patients, those with low albumin, high APACHE II scores, or after cardiopulmonary resuscitation, suggesting limited benefit from ventilation in these cases.
Area of Science:
- Critical Care Medicine
- Geriatric Medicine
- Pulmonary Medicine
Background:
- Mechanical ventilation is a life-support measure used in intensive care units.
- Predicting mortality in mechanically ventilated patients is crucial for clinical decision-making.
- The Department of Veterans Affairs conducted a study on veteran mortality predictors.
Purpose of the Study:
- To identify predictors of in-hospital and 1-year mortality in mechanically ventilated veterans.
- To evaluate the effectiveness of mechanical ventilation in specific patient subsets.
Main Methods:
- Retrospective cohort study of 612 mechanically ventilated patients from 6 medical intensive care units.
- Data collected on patient demographics, clinical factors, and outcomes (vital status at discharge and 1 year).
- Analysis included calculation of mortality rates and comparison with Acute Physiology and Chronic Health Evaluation II (APACHE II) predicted mortality.
Main Results:
- Overall hospital mortality was 64%, with a 1-year mortality of 77%.
- Higher mortality was associated with advanced age (>70 years), low serum albumin (<20 g/L), high APACHE II scores (>35), and post-cardiopulmonary resuscitation ventilation.
- Mortality rates for these high-risk groups approached or exceeded 90% at 1 year.
Conclusions:
- Patient age, APACHE II score, serum albumin levels, and cardiopulmonary resuscitation status are significant predictors of mortality.
- Mechanical ventilation may offer limited benefit for specific subsets of critically ill veterans.
- These factors can help identify patients for whom mechanical ventilation may not be beneficial.