Critically ill patients who have been mechanically ventilated for more than seven days are at greatly increased risk for functional impairment and mortality at one year following discharge from the intensive care unit (ICU), according to a study presented at the 2015 American Thoracic Society International Conference.
"Prolonged mechanical ventilation has a significant impact on the long-term well-being of patients," said Margaret Herridge. MD, MPH. of the University of Toronto. "In our study of nearly 400 ICU patients, we were able to identify a number of characteristics that predicted subsequent disability. Knowing these risk factors can help guide their rehabilitation needs."
Several complications can develop from mechanical ventilation during ICU stay, such as pressure ulcers (OR 9.18, 95% CI 6.64 - 12.7), muscle weakness (OR 6.99, 95% CI 4.94-9.82), infection (bacterial sepsis (OR 5.18, 95% CI 3.75 - 7.15), candidemia (OR 3.82, 95% CI 1.31 - 11.09) and pulmonary embolism (OR 3.71, 95% CI 1.43 - 9.63).
Ventilator-associated pneumonia is the most serious risk of long-term ventilator use. The breathing tube provides an open pathway for bacteria to enter the lungs. It also makes coughing difficult, and coughing is the body’s way of expelling irritants from the lungs and airway that may otherwise cause infection.
Long-term use of a ventilator also carries the risk of pneumothorax, air leaking from the lungs into the space between the lungs and the chest wall. Pneumothorax can cause one or both lungs to collapse.
Additionally There are long term emotional and cognitive effects of being sedated in the ICU.
Critical care doctors know that the longer patients remain in the ICU, the more likely they are to suffer the long-term effects of being sedated.
In fact, those effects have a name: "post-intensive care syndrome (PICS)." Some physicians call it post-ICU delirium.
"The longer somebody is in the ICU, the more they're at risk," Dr. Amy Bellinghausen, a pulmonary, critical care fellow at the University of California, San Diego, said.
The longer somebody is in the ICU, the more they're at risk.
When patients recover to the point of being discharged, cognitive difficulties may follow.
"Often when patients come out of the ICU, they really struggle to think as clearly as they did before," Bellinghausen said. "Sometimes it's as simple as not being able to figure out how to find the shared drive at work anymore, or what's on the schedule for the next day."
A number of factors can lead to PICS, including the use of ventilators and pain or sedative medications. These measures can have “mind-altering” effects, according to the Cleveland Clinic.