TY - JOUR AU - Lai, Chih-Cheng AU - Tseng, Kuei-Ling AU - Ho, Chung-Han AU - Chiang, Shyh-Ren AU - Chen, Chin-Ming AU - Chan, Khee-Siang AU - Chao, Chien-Ming AU - Hsing, Shu-Chen AU - Cheng, Kuo-Chen PY - 2019 TI - Prognosis of patients with acute respiratory failure and prolonged intensive care unit stay JF - Journal of Thoracic Disease; Vol 11, No 5 (May 31, 2019): Journal of Thoracic Disease Y2 - 2019 KW - N2 - Background: Reasons for the prolonged critical care support include uncertainty of outcome, the complex dynamic created between physicians with care team members and the patient’s family over a general unwillingness to surrender to unfavorable outcomes. The purpose of this study was to investigate outcomes and identify risk factors of patients with acute respiratory failure (ARF) who required a prolonged intensive care unit (ICU) stay (≥21 days). It may provide reference to screen patients who are suitable for hospice care. Methods: The medical records of all ARF patients with a prolonged ICU stay were retrospectively reviewed. The primary outcome was in-hospital mortality. Results: We identified 1,189 patients. Sepsis (n=896, 75.4%) was the most common cause of prolonged ICU stays, following by renal failure (n=232, 19.5%), and unstable hemodynamic status vasopressors or arrhythmia (n=208, 17.5%). Using multivariable logistic regression, we identified eight risk factors of death: age >75 years, ICU stay for more than 28 days, APACHE II score ≥25, unstable hemodynamic status, renal failure, hepatic failure, massive gastrointestinal tract bleeding, and using a fraction of inspired oxygen (FiO 2 ) ≥40%. The overall in-hospital mortality rate was 53.6% (n=637), and it up to 75.3% (216/287) for patients with at least three risk factors. Conclusions: The outcome of patients with ARF who required prolonged ICU stay was poor. They had a high risk of in-hospital mortality. Palliative care should be considered as a reasonable option for the patients at high risk of death. UR - https://jtd.amegroups.org/article/view/28539