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What Happens to People Who Need a Breathing Machine for More Than a Few Days? FREE

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The summary below is from the full report titled “One-Year Trajectories of Care and Resource Utilization for Recipients of Prolonged Mechanical Ventilation. A Cohort Study.” It is in the 3 August 2010 issue of Annals of Internal Medicine (volume 153, pages 167-175). The authors are M. Unroe, J.M. Kahn, S.S. Carson, J.A. Govert, T. Martinu, S.J. Sathy, A.S. Clay, J. Chia, A. Gray, J.A. Tulsky, and C.E. Cox.

Ann Intern Med. 2010;153(3):I-56. doi:10.7326/0003-4819-153-3-201008030-00003
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What is the problem and what is known about it so far?

Breathing machines are an important treatment for sick people in intensive care units (ICUs). People who are sick in ICUs often choose to go on breathing machines because they want to do everything they can to get better, because they do not want to give up hope, or because their doctor advises them that the treatment is temporary. If a person is sick enough to require treatment with a breathing machine for more than 1 or 2 weeks, doctors recommend putting a small hole in the person's throat (tracheostomy). Providing ventilation through a breathing tube inserted into that hole is possibly more comfortable for the person, is safer for their vocal cords and airways, and is self-healing once the tube is removed. However, some people depend on breathing machines even after tracheostomy and even after their condition has improved enough for them to leave the ICU and hospital. Doctors have long suspected that people who require a breathing machine for much longer than average do not do well, regardless of whether they are eventually able to be weaned off of it. However, information about what happens to those people medically has not been carefully collected.

Why did the researchers do this particular study?

To describe what happens to people who require a breathing machine for more than a few days in the year after their initial illness.

Who was studied?

126 people treated in 5 ICUs at Duke University Medical Center.

How was the study done?

The researchers first identified people who required breathing machines for much longer than average or who received a tracheostomy while receiving treatment in the ICU. Researchers interviewed these people or their family members at 3 months and 1 year to find out how they were doing and collected information about their medical care from medical records.

What did the researchers find?

In general, the group did not do well. About one third of participants could not be weaned off of the breathing machine. A total of 56 people died, and only 11 people were alive and able to function independently at the end of the year. Doctors had predicted good outcomes for those 11 people, but they had also predicted good outcomes for study participants in general, most of whom fared poorly. Most people required additional care and transfers between facilities and hospitals. Medical care for each person over the year cost an estimated $3.5 million.

What were the limitations of the study?

Study participants were cared for at a single medical center hospital. The findings might be different in other locations or regions of the country with different patterns of care. Some of the study outcomes were reported by the participants themselves and could not be or were not verified.

What are the implications of the study?

Patients who require a breathing machine for much longer than average during an initial illness have poor outcomes in the next year. If they survive, they are often seriously disabled and require extensive care. When making the decision for a patient to go on a breathing machine or to continue using one for longer periods, patients, family members, and doctors hoping for good outcomes should consider these sobering observations.





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