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Intensive Care Medicine

, Volume 45, Issue 12, pp 1742–1752 | Cite as

Frailty and invasive mechanical ventilation: association with outcomes, extubation failure, and tracheostomy

  • Shannon M. FernandoEmail author
  • Daniel I. McIsaac
  • Bram Rochwerg
  • Sean M. Bagshaw
  • John Muscedere
  • Laveena Munshi
  • Niall D. Ferguson
  • Andrew J. E. Seely
  • Deborah J. Cook
  • Chintan Dave
  • Peter Tanuseputro
  • Kwadwo Kyeremanteng
Original

Abstract

Purpose

Invasive mechanical ventilation is a common form of life support provided to critically ill patients. Frailty is an emerging prognostic factor for poor outcome in the Intensive Care Unit (ICU); however, its association with adverse outcomes following invasive mechanical ventilation is unknown. We sought to evaluate the association between frailty, defined by the Clinical Frailty Scale (CFS), and outcomes of ICU patients receiving invasive mechanical ventilation.

Methods

We performed a retrospective analysis (2011–2016) of a prospectively collected registry from two hospitals of consecutive ICU patients ≥ 18 years of age receiving invasive mechanical ventilation. CFS scores were based on recorded pre-admission function at the time of hospital admission. The primary outcome was hospital mortality. Secondary outcomes included discharge to long-term care, extubation failure at time of first liberation attempt, and tracheostomy.

Results

We included 8110 patients, and 2529 (31.2%) had frailty (CFS ≥ 5). Frailty was associated with increased odds of hospital death (adjusted odds ratio [aOR]: 1.24 [95% confidence interval [CI] 1.10–1.40) and discharge to long-term care (aOR 1.21 [95% CI 1.13–1.35]). As compared to patients without frailty, patients with frailty had increased odds of extubation failure (aOR 1.17 [95% CI 1.04–1.37]), hospital death following extubation failure (aOR 1.18 [95% CI 1.07–1.28]), tracheostomy (aOR 1.17 [95% CI 1.01–1.36]), and hospital death following tracheostomy (aOR 1.14 [95% CI 1.03–1.25]).

Conclusions

The presence of frailty among patients receiving mechanical ventilation is associated with increased odds of hospital mortality, discharge to long-term care, extubation failure, and need for tracheostomy.

Keywords

Frailty Mechanical ventilation Extubation failure Tracheostomy 

Notes

Author contributions

SMF, DIM, BR, SMB, JM, and KK designed the study. SMF, CD, and KK gathered the data. SMF, DIM, BR, SMB, JM, LM, NDF, AJES, DJC, PT, and KK analyzed the data. All the authors wrote the manuscript.

Funding

None.

Compliance with ethical standards

Conflicts of interest

Dr. Daniel I. McIsaac is supported by the Canadian Anesthesiologists’ Society Career Scientist Award. Dr. Sean M. Bagshaw is supported by a Canada Research Chair in Critical Care Nephrology. Dr. John Muscedere is the Scientific Director of the Canadian Frailty Network. Dr. Andrew J. E. Seely holds patents related to multiorgan variability analysis, and has shares in Therapeutic Monitoring Systems Inc. Dr. Deborah J. Cook is supported by a Canada Research Chair in Critical Care Knowledge Translation. None of the other authors report any conflict of interest.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Shannon M. Fernando
    • 1
    • 2
    Email author
  • Daniel I. McIsaac
    • 3
    • 4
    • 5
  • Bram Rochwerg
    • 6
    • 7
  • Sean M. Bagshaw
    • 8
  • John Muscedere
    • 9
  • Laveena Munshi
    • 10
    • 11
  • Niall D. Ferguson
    • 10
    • 12
  • Andrew J. E. Seely
    • 1
    • 4
    • 5
    • 13
  • Deborah J. Cook
    • 6
    • 7
  • Chintan Dave
    • 14
  • Peter Tanuseputro
    • 4
    • 5
    • 15
    • 16
  • Kwadwo Kyeremanteng
    • 1
    • 5
    • 16
    • 17
  1. 1.Division of Critical Care, Department of MedicineUniversity of OttawaOttawaCanada
  2. 2.Department of Emergency MedicineUniversity of OttawaOttawaCanada
  3. 3.Department of Anesthesiology and Pain MedicineUniversity of OttawaOttawaCanada
  4. 4.School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
  5. 5.Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
  6. 6.Division of Critical Care, Department of MedicineMcMaster UniversityHamiltonCanada
  7. 7.Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
  8. 8.Department of Critical Care Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  9. 9.Department of Critical Care MedicineQueen’s UniversityKingstonCanada
  10. 10.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  11. 11.Department of MedicineSinai Health SystemTorontoCanada
  12. 12.Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
  13. 13.Department of SurgeryUniversity of OttawaOttawaCanada
  14. 14.Department of MedicineUniversity of OttawaOttawaCanada
  15. 15.Bruyere Research InstituteOttawaCanada
  16. 16.Division of Palliative Care, Department of MedicineUniversity of OttawaOttawaCanada
  17. 17.Institut du Savoir MontfortOttawaCanada

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