Frailty and invasive mechanical ventilation: association with outcomes, extubation failure, and tracheostomy
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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.
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.
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]).
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.
KeywordsFrailty Mechanical ventilation Extubation failure Tracheostomy
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.
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.
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