Incidence and Outcomes of Prolonged Acute Mechanical Ventilation of Surgical Patients in Academic Hospitals
Onuma Chaiwat MD*, Kaweesak Chittawatanarat MD**, Annop Piriyapathsom MD*, Chawika Pisitsak MD***, Suneerat Kongsayreepong MD*
Affiliation : * Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand *** Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objective : To identify incidence, outcomes and risk factors of prolonged acute mechanical ventilation (PAMV) in surgical
patients admitted to surgical intensive care units (ICUs) of two large academic hospitals in Thailand.
Material and Method: This is a retrospectively analyses of the THAI-SICU database which is a multi-center, prospective,
observational cohort study to identify the adverse events and mortality in surgical ICUs. The new term PAMV was defined as
the requirement of mechanical ventilation for longer than 4 days.
Results : A total of 1,084 patients were included in this study. The incidence of PAMV in this cohort was approximately 40%.
PAMV patients demonstrated significantly higher percentage of clinical complication including stroke, seizure, sepsis, upper
gastrointestinal hemorrhage, acute kidney injury and adult respiratory distress syndrome (ARDS)/acute lung injury (ALI)
than patients who required mechanical ventilation <4 days. Sepsis, non-operative and controlled mechanical ventilation on
admission were identified as independent risk factors for PAMV. Patients who had sepsis were 3.2 times higher risk associated
with PAMV (adjusted odds ratio (OR) 3.25, 95% confidence interval (CI) 2.25 to 4.7) and patients who were non-operative
and on controlled mechanical ventilation (CMV) on admission were approximately 2.5-fold higher risk associated with PAMV.
Conclusion : The incidence of PAMV was 40% in surgical ICU patients. The mortality and complication rate were higher in
PAMV patients.
Keywords : Prolonged mechanical ventilation, Acute, Surgical patients, Intensive care unit, Mortality
