Long-term prognosis of older adults who survive emergency mechanical ventilation

Abstract Context Emergent mechanical ventilation represents an important inflection point in seriously ill older adults' illness trajectories. Data is lacking on the long-term prognosis after surviving mechanical ventilation to inform shared decision-making in serious illness conversations. Objective Describe the long-term prognosis of older adults who survive emergency mechanical ventilation to inform shared decision-making. Methods This is a retrospective cohort study from a single-center, intensive care unit (ICU) in an academic, urban, tertiary care medical center. We included adults aged ≥75 years consecutively admitted with mechanical ventilation between 2008 and 2012 in the Multi-Parameter Intelligent Monitoring of Intensive Care III database. We excluded patients who were electively admitted. Our primary outcome was the long-term prognosis after leaving the hospital stratified by discharge location. Our secondary outcome was the frequency of documented serious illness conversations within 48 hours of hospitalization recommended by the National Quality Forum. Results We identified 415 patients (454 hospital admissions) consecutively admitted to the ICU. The median age was 82.6 years, 54% were female, 78.2% were white, non-Hispanic, and in-hospital mortality rate was 36.6%. Among the survivors, the median survival after hospital discharge was 163.5 days (IQR 37.5-476.8). Only 49.1% of patients had documented serious illness conversations within 48 hours of hospitalization. 63% of patients (59 out of 93) who were discharged to LTACH died by six months. Conclusion This study demonstrated the long-term prognosis of older adults who underwent emergent mechanical ventilation. This data could be used to inform shared decision-making in serious illness conversations.