Nav: Home

ICU ventilators overused with advanced-dementia patients

October 10, 2016

Mechanical ventilation may be lifesaving, but in certain patient cases it may prolong suffering without a clear benefit.

JAMA Internal Medicine today published a study of 635,008 hospitalizations of nursing-home patients with advanced dementia and severe functional impairment. Between 2000 and 2013, the use of mechanical ventilation nearly doubled among these patients in some 2,600 cohort hospitals, yet the one-year mortality of ventilated patients remained above 80 percent.

The increasing use of mechanical ventilation raises concerns of patient suffering and the societal costs of care, said Dr. Joan Teno, a UW Medicine palliative care specialist and the study's corresponding author. She is a professor of medicine, gerontology and geriatrics at the University of Washington School of Medicine.

"These findings call for new efforts to ensure that the use of mechanical ventilation is consistent with patient's goals of care and their clinical condition," Teno said.

"We want to raise a fundamental policy question of how to improve end-of-life care, and particularly for very vulnerable populations. We want caregivers to think and talk about whether this type of care is achieving the patient's goals and value for society," she said.

In a previous study Teno co-authored, 96 percent of family members of similar patients wanted care to focus on comfort rather than on medical goals such as survival and organ function.

Teno and colleagues sought to understand the use and outcomes of mechanical ventilation and its relationship with the increasing numbers of ICU beds in U.S. hospitals. The study involved patients, age 84, on average, who were in in a nursing home for 120 days before hospital admission. They all had advanced-stage dementia and 98 percent were bedbound.

The researchers found an association between a hospital's number of ICU beds and its use of mechanical ventilation: Over time, being hospitalized at a hospital that increased its ICU beds by 10 was associated with 6 percent higher likelihood of mechanical ventilation.

In 2013, the last year of the study, hospitals in the highest-decile number of ICU beds deployed ventilators to this patient population in 10.6 percent of cases; by contrast, hospitals in the lowest-decile number of ICU beds deployed ventilators in 4.5 percent of cases.

Between those same two decile groups, per-patient reimbursement and length of hospital stay differed markedly, as well. However, scant difference was seen in one-year mortality of those patients.

"While it is rarely known in advance that a treatment like mechanical ventilation in the ICU is futile for a given patient, it would be sad to think that a vulnerable patient was admitted to an ICU merely to fill a recently built empty bed which our data suggests may be happening," said co-author Dr. Vincent Mor, professor of health services, policy and practice in the Brown University School of Public Health.

Nursing homes can do more to educate families about patients' prognoses and the benefits and risks of hospitalization, Teno suggested, and hospitals need to ensure that decisions to employ life-sustaining interventions reflect patient-informed goals of care. Further, she said, a national strategic plan is needed regarding regional ICU bed growth.
This research was funded by a National Institutes of Health / National Institute of Aging grant (2P01AG027296-06A1) to Brown University and the UW's Cambia Palliative Care Center of Excellence.

University of Washington Health Sciences/UW Medicine

Related Mechanical Ventilation Articles:

A mechanical trigger for toxic tumor therapy
Cell-killing chemotherapies are designed to shrink cancerous tumors by accumulating in their ill-formed blood and lymph vessels, delivering a toxic dose to the cancer cells.
Addition of in-home noninvasive ventilation to oxygen therapy improves outcomes following COPD exacerbation
Among patients with an excess of carbon dioxide in their blood (persistent hypercapnia) following a flare-up (acute exacerbation) of chronic obstructive pulmonary disease (COPD), in-home use of a mask and machine to support breathing in addition to home oxygen therapy prolonged the time to hospital readmission or death, according to a study published by JAMA.
Microdevice provides novel method of measuring cell mechanical properties
Researchers from Kumamoto University in Japan have developed a new method of measuring the Young's modulus of a cell.
Sealing properties and its influence factors of spherical mechanical seal
The spherical mechanical seal which can automatically adjust the contact state of sealing surfaces is proposed to replace the frequently used plane mechanical seal in order to solve the problems that when a marine stern shaft is bent with shafting misalignment and stern bearing wear factors, etc., the sealing properties of a plane mechanical seal is declined with the increase of both contact pressure and temperature of sealing surface.
Where cells go: Mechanical and chemical cues collaborate to guide them
Living cells respond to biochemical signals by moving toward those at higher concentration, a process carefully mapped out by biologists over the past several decades.
New guidelines published for discontinuing mechanical ventilation in ICU
The American College of Chest Physicians (CHEST) and the American Thoracic Society (ATS) have published new guidelines for discontinuing mechanical ventilation in critically ill adults.
Helmet-based ventilation is superior to face mask for patients with respiratory distress
A study, published early online in JAMA, shows that using a transparent air-tight helmet instead of a face mask helps critically ill patients breathe better and can prevent them from needing a ventilator.
New trigger for self-powered mechanical movement
A new way to use the chemical reactions of certain enzymes to trigger self-powered mechanical movement has been developed by a team of researchers at Penn State University and the University of Pittsburgh.
Drug does not significantly reduce duration of mechanical ventilation for COPD patients
Among mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) and metabolic alkalosis, administration of the respiratory stimulant acetazolamide did not significantly reduce the duration of invasive mechanical ventilation, according to a study in the Feb.
Mechanical quanta see the light
Interconnecting different quantum systems is important for future quantum computing architectures, but has proven difficult to achieve.

Related Mechanical Ventilation Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Failure can feel lonely and final. But can we learn from failure, even reframe it, to feel more like a temporary setback? This hour, TED speakers on changing a crushing defeat into a stepping stone. Guests include entrepreneur Leticia Gasca, psychology professor Alison Ledgerwood, astronomer Phil Plait, former professional athlete Charly Haversat, and UPS training manager Jon Bowers.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".