Predictors of prolonged mechanical ventilation identified at an emergency visit for elderly people: A retrospective cohort study

The aim of this study was to determine the factors that are associated with prolonged mechanical ventilation in elderly patients. Retrospective cohort study Single tertiary hospital in Japan We retrospectively identified 228 patients aged 75 years or older who were admitted to a single tertiary care center in Japan between January 1, 2014 and December 31, 2017 because of endogenous diseases and underwent mechanical ventilation. The primary outcome was extubation difficulty, which was defined as the need for mechanical ventilation for more than 14 days after intubation, reintubation within 72 hours after extubation, tracheotomy or extubation, or death within 14 days after intubation. A multivariate analysis showed that age (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.66–1.38; P = .80), gender (OR = 0.56; 95%CI = 0.27–1.17; P = .13), body mass index (BMI) (OR = 1.05; 95%CI = 0.98–1.14; P = .16), smoking history (OR = 0.64; 95%CI = 0.29–1.41; P = .27), Activities of daily living (ADL) (OR = 0.95; 95%CI = 0.49–1.83; P = .87), and modified acute physiology and chronic health evaluation (APACHE) II score (OR = 1.02; 95%CI = 0.95–1.09; P = .61) were not statistically significantly different. However, there were statistically significant differences in extubation difficulty between patients with diabetes mellitus (OR = 2.3; 95%CI = 1.01–5.12; P = .04) and those with cardiovascular disease diagnosis on admission (OR = 0.31; 95%CI = 0.1–0.97; P = .04). Diabetes mellitus and cardiovascular disease diagnosis on admission were factors that were associated with prolonged mechanical ventilation in the elderly. The results of this study may help to support shared decision making with patients or surrogate decision makers at the start of intensive care in the elderly.