Am. J. Respir. Crit. Care Med.,
Volume 159, Number 5, May 1999, 1568-1573
Outcomes after Long-Term Acute Care
An Analysis of 133 Mechanically Ventilated Patients
SHANNON S.
CARSON,
PETER B.
BACH,
LORAINE
BRZOZOWSKI,
and
ALAN
LEFF
Departments of Medicine, Pediatrics, Anaesthesia, and Critical Care, Robert Wood Johnson Clinical Scholars Program,
and Harris School of Public Policy, University of Chicago, Chicago, Illinois
Long-term acute-care (LTAC) hospitals are facilities exempt from the Medicare prospective payment
system and which provide care to patients suffering from prolonged critical illness. From August 1, 1995 to July 31, 1996, we studied the outcomes of 133 mechanically ventilated patients who were
consecutively admitted to a large urban LTAC hospital from intensive care units (ICUs) of acute-care
hospitals. Survival and functional status within 1 yr after the index admission were measured, and
specific patient variables were used to develop a predictive model for survival at 1 yr. Of the 133 patients studied, 66 (50%) died prior to discharge. Of discharged patients, 70% had been successfully
liberated from mechanical ventilation. One year after LTAC hospital admission, 103 (77%) of the patients had expired, typically after spending the majority of their days in acute care or long-term care
facilities. Eleven 1-yr survivors (8%) were fully functional, whereas the remainder had significantly reduced functional status. Patients older than 74 yr, and patients older than 64 yr and not functionally independent before admission, had a 95% (confidence interval [CI]: 84% to 99%) 1-yr mortality; patients without these characteristics had a 56% (CI: 41% to 71%) 1-yr mortality (p < 0.001). We demonstrate characteristics predicting the poorest prognoses for patients requiring prolonged mechanical ventilation. These characteristics may be identifiable before transfer to an LTAC hospital.