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American Journal of Critical Care. 2006;15: 65-77
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Preferences for Mechanical Ventilation Among Survivors of Prolonged Mechanical Ventilation and Tracheostomy

By Kathleen Guentner, RN, PhD, Leslie A. Hoffman, RN, PhD, Mary Beth Happ, RN, PhD, Yookyung Kim, PhD, Annette DeVito Dabbs, RN, PhD, Aaron B. Mendelsohn, PhD, MPH and Lakshmipathi Chelluri, MD. From Nursing Quality and Outcomes, University of Pittsburgh Medical Center (KG), Department of Acute/Tertiary Care (LAH, MBH, ADD) and Department of Health and Community Systems (YK), University of Pittsburgh School of Nursing, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health (ABM), and Department of Critical Care Medicine, University of Pittsburgh School of Medicine (LC), Pittsburgh, Pa.

• Background Among survivors of prolonged mechanical ventilation, preferences for this treatment have rarely been explored.

• Objectives To elicit preferences of survivors of prolonged mechanical ventilation (≥7 days) and factors influencing these preferences.

• Methods A descriptive, cross-sectional survey design was used. Subjects were recruited from intensive care units in a tertiary care hospital and from long-term care facilities. Each subject (n = 30) was asked to reflect on the decision to use mechanical ventilation; rate current health, pain/discomfort in the intensive care unit and from mechanical ventilation, perceived family financial burden, and emotional/physical stress related to mechanical ventilation; identify changes that would influence preference for mechanical ventilation; and answer questions about quality of life, functional status, depressive symptoms, and communication.

• Results Most subjects (75.9%) would have chosen mechanical ventilation. Median days of mechanical ventilation and tracheostomy were greater for subjects who would have chosen mechanical ventilation (98.5 vs 70), as were median days of tracheostomy (102 vs 64). Patients who would not have chosen mechanical ventilation had more depressive symptoms and were more likely to be insured by Medicare. No other variables differed between groups. Patients who preferred mechanical ventilation would change their preference on the basis of their families’ emotional/physical stress and financial burden. Patients who did not prefer mechanical ventilation would change their preference if the family financial burden and emotional/physical stress were reduced and current health improved.

• Conclusions Most patients would have chosen mechanical ventilation. Survivors’ preferences were influenced by their current health and families’ financial burden and stress.




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[Abstract] [Full Text] [PDF]


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