Transitions to different care settings or death among recipients of prolonged mechanic ventilation: A trajectory model based on longitudinal health insurance and death certificate data

Objective: To examine transitions to different care settings or death after receiving prolonged mechanical ventilation (PMV), and investigate factors associated with post-PMV trajectories of care and mortality.

Methods: We used secondary and prospectively collected data from the National Health Insurance Research Database and the death certificates database of Taiwan for a national representative sample of 35,671 new PMV patients in 2002-2007. We extracted data from patients' historic inpatient records and medical orders to construct records regarding all post-PMV transitions to different care settings or death, and used multinomial logit regression to determine factors associated with post-PMV probabilities of moving to various care settings or death.

Results: At the PMV onset, almost 60% of patients were in intensive care units (ICU), 26% were in general wards, and 14% were in respiratory care centers. We observed 130,684 transitions among these patients. Among patients in an ICU setting, the 3-month, 6-month and 1-year death rates were 51.1%, 60.9%, and 69.4%. Other patients had slightly lower mortality. Over 30% patients in general wards were sent to an ICU setting within one month after the PMV onset. The following conditions were significantly linked to transitions to death or back to an ICU setting from a less intensive care setting: neoplasm, acute and unspecific renal failure, chronic renal failure, septicemia, and shock.

Conclusion: The death rate is high after receiving PMV. A substantial proportion of patients in general wards at the PMV onset have to move to an ICU setting within one month.