Long-term survival, psychiatric, physiological, and functional outcomes of critically ill patients requiring prolonged mechanical ventilation: a systematic review

ABSTRACT Purpose Invasive mechanical ventilation is utilized in over 50% of Australian Intensive Care Unit patients, with rates increasing world-wide. Prolonged mechanical ventilation is associated with increased length of hospital stay and in-hospital mortality compared with patients ventilated under the time threshold. Previous studies have highlighted mortality rates, but much remains unknown regarding the long-term physiological, functional, and psychiatric effects of prolonged mechanical ventilation. With a greater understanding of these outcomes, models of care can be formulated to reduce long-term morbidity. Methods Medline, CINAHL and the Cochrane Library were searched between 1998 and March 2019, for PMV, patients in ICU and long-term outcomes. Included studies had patients, that received greater than or equal to 14 days of IMV. Primary outcome was mortality rates with secondary outcomes clustered into physiological, functional, and psychiatric outcomes. Results 1057 studies were identified, with 24 included. 73% of PMV patients were discharged from ICU, with mortality rates of 57% and 69% at 12 and 48 months. 30.2% were discharged home, 25% developed new onset ventilator acquired pneumonia and up to 39% experienced psychiatric complications. Conclusion Despite a high proportion of patients surviving to hospital discharge, subsequent outcomes are extremely poor for patients that require PMV.