PROGNOSIS OF MECHANICALLY VENTILATED PATIENTS

In this Department of Veterans Affairs cooperative study, we examined predictors of in-hospital and 1-year mortality of 612 mechanically ven tilated patients from 6 medical intensive care units in a retrospectiv e cohort design. The outcome variable was vital status at hospital dis charge and after 1 year. The results showed that 97% of patients were men, the mean age was 63 +/- 11 years (SD), and hospital mortality was 64% (95% confidence interval, 60% to 68%). Within the next year, an a dditional 38% of hospital survivors died, for a total 1-year mortality of 77% (95% confidence interval, 73% to 80%). Hospital and 1-year mor tality, respectively, for patients older than 70 years was 76% and 94% , for those with serum albumin levels below 20 grams per liter it was 92% and 96%, for those with an Acute Physiology and Chronic Health Eva luation II (APACHE II) score greater than 35 it was 91% and 98%, and f or patients who were being mechanically ventilated after cardiopulmona ry resuscitation it was 86% and 90%. The mortality ratio (actual morta lity versus APACHE II-predicted mortality) was 1.15. Conclusions are t hat patient age, APACHE II score, serum albumin levels, or the use of cardiopulmonary resuscitation may identify a subset of mechanically ve ntilated veterans for whom mechanical ventilation provides little or n o benefit.