How patients feel about prolonged mechanical ventilation 1 year later.

View Abstract

OBJECTIVES

To elicit mechanical ventilation preferences among patients who previously received prolonged (>/=48 hrs) mechanical ventilation, to identify patient characteristics associated with mechanical ventilation preferences, and to assess the association between the intensive care experience and mechanical ventilation preferences.

DESIGN

Prospective cohort study conducted between June of 1997 and July of 2000.

SETTING

Four intensive care units at a tertiary care institution.

PATIENTS

Former critically ill patients (n = 133; mean age +/- sd, 51.8 +/- 17.1 yrs; 49% women) who survived for 12 months after prolonged mechanical ventilation.

MEASUREMENTS

Patients' preferences toward their actual mechanical ventilation experiences, by asking patients to reflect on the decision to apply mechanical ventilation made 1 yr earlier. Preferences for hypothetical situations, by asking patients to evaluate mechanical ventilation choices, assuming that their experiences had been different in terms of pain or discomfort, familial financial burden and stress, and health status after mechanical ventilation.

RESULTS

Of the 133 patients, 115 (86.5%) would have chosen mechanical ventilation, with younger and healthier patients having higher odds of choosing mechanical ventilation than older and sicker patients, respectively. One fourth of patients who initially would have chosen mechanical ventilation would have refused this therapy had their families' financial burdens been beyond certain thresholds. A similar proportion would have refused mechanical ventilation with greater mechanical ventilation pain or discomfort.

CONCLUSION

Although most subjects would have made the same decision to receive mechanical ventilation, younger and healthier subjects were most likely to favor mechanical ventilation. Many patients indicated that factors such as the amount of pain or discomfort from mechanical ventilation and their families' financial burden would cause them to refuse this potentially life-saving intervention.

Investigators
Abbreviation
Crit. Care Med.
Publication Date
2003-11-03
Volume
30
Issue
7
Page Numbers
1439-45
Pubmed ID
12828184
Medium
Print
Full Title
How patients feel about prolonged mechanical ventilation 1 year later.
Authors
Mendelsohn AB, Belle SH, Fischhoff B, Wisniewski SR, Degenholtz H, Chelluri L,