Preferences for mechanical ventilation among survivors of prolonged mechanical ventilation and tracheostomy

Kathleen Guentner, Leslie A Hoffman, Mary Beth Happ, Yookyung Kim, Annette Devito Dabbs, Aaron B Mendelsohn, Lakshmipathi Chelluri
American Journal of Critical Care 2006, 15 (1): 65-77

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 (>or=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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