Major Finding: In 996 patients on mechanical ventilation longer than expected, standardized mortality ratios were 0.74 for the ICU and 0.77 for the hospital.
Data Source: Single-center review of 5,345 patients ventilated on their first day in the ICU during the period 2004-2009.
Disclosures: None were reported.
MIAMI BEACH — Patients who exceeded their expected time on mechanical ventilation by 2 or more days fared no worse than did those who were weaned within predicted times, based on discharge rates and follow-up at 30, 60, and 90 days.
Of 5,345 patients who were mechanically ventilated on their first ICU day, nearly 19% (996) were outliers. Yet survival was better than expected in this group, with standardized mortality ratios of 0.74 for the ICU and 0.77 for the hospital. In other terms, 65 of the 996 patients in the outlier group were “unexpected survivors,” Kelly Becker, R.N., said at the annual congress of the Society of Critical Care Medicine.
Survival to, 30, 60, and 90 days was assessed for a subset of 99 patients ventilated in 2008. Of those patients, 75% survived for at least 90 days post discharge.
“We did not have the outcomes we expected at all—we were surprised,” Ms. Becker said in an interview at a poster she copresented with Sue Hanna. Both presenters are affiliated with Borgess Medical Center, a 424-bed research and teaching hospital in Kalamazoo, Mich.
“Length of stay and length of time on a ventilator does not always measure how well you are taking care of a patient who is critically ill,” she remarked.
Patients in the study were on mechanical ventilation between November 2004 and July 2009. The median APACHE score was 78 (range, 74-104). Nearly half (48%) were aged 65 years or older.
In aggregate, the patients who exceeded their expected mechanical ventilation time by at least 2 days (the APACHE IV definition of ventilator outlier) had 9,163 more total days of mechanical ventilation than predicted. Similarly, this group spent 10,956 more days than expected in the ICU and 9,750 additional days in the hospital.
The study is ongoing, with more patients being recruited, Ms. Becker said.