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ADVANCE Perspective: Respiratory Views

Older Survivors of Mechanical Ventilation Can Expect Significant Disability

Published January 12, 2011 9:43 AM by Valerie Newitt

Patients aged 65 and older who survive use of mechanical ventilation during a hospitalization are more likely to suffer from long-term disabilities after leaving the hospital than those who survive hospitalization without mechanical ventilation, according to researchers at the University of Pittsburgh. The study was published online and distributed by Newswire ahead of the print edition of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

"Our findings offer the first nationally-representative estimates of functional status outcomes for elderly patients who have survived mechanical ventilation, using a prospective population-based sample," Amber Barnato, MD, associate professor of medicine, University of Pittsburgh, told Newswire. "Unfortunately, 70 percent of elders who receive mechanical ventilation will not survive the year. And the 30 percent who are strong enough to survive will be very disabled."

Previous studies of the effects of mechanical ventilation on elderly patients have offered conflicting results, and were limited by their local patient sampling and lack of first-person information about physical function before the illness. "This study puts to rest the controversy: Doctors can confidently tell their elderly patients that if they survive an episode of mechanical ventilation they will be much more disabled than before, and may require nursing home care," noted Dr. Barnato.

The researchers used data collected over a seven-year period in the Medicare Current Beneficiary Survey (MCBS), a continuous survey of a nationally representative sample of aged, disabled and institutionalized Medicare beneficiaries sponsored by the Centers for Medicare and Medicaid Services. MCBS conducts in-person interviews with each sampled beneficiary four times per year for four years. Questions related to health and functional status are asked every autumn. For this study, the researchers linked beneficiaries' survey responses from the autumn survey with their responses one year later. Beneficiaries who were hospitalized during the 12-month period and who survived until their next autumn interview were included and divided into two groups: those who had received mechanical ventilation during hospitalization and those who had not. The researchers reviewed more than 130,000 person-years of data, from which about 12,000 person-years of data qualified for inclusion in the study.

Researchers rated patients' pre- and post-hospitalization disability levels with regard to mobility and activities of daily living (ADL), rating patients in both areas using scores ranging from 0 (not disabled) to 100 (completely disabled). Comparing the two groups, the researchers found those who survived mechanical ventilation experienced 30 percent greater ADL disability (14.9 vs. 11.5) and 14 percent greater mobility difficulty (25.4 vs. 22.3) than non-ventilated counterparts.

"This is especially important because the pre-hospitalization scores of the patients who were and weren't mechanically ventilated were similar," Dr. Barnato said. "Being sick enough to require mechanical ventilation, and perhaps even the experience of mechanical ventilation itself, really takes the vim and vigor out of people." Although mechanical ventilation may be lifesaving, the possibility of prolonged disability could influence health care decision-making, she noted.

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