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Frailty and Associated Outcomes Following Invasive Mechanical Ventilation
CCCF Academy. Fernando S. 11/12/19; 283356; EP88
Dr. Shannon Fernando
Dr. Shannon Fernando
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ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Fernando, Shannon M., MD, MSc1,2; McIsaac, Daniel I., MD, MPH3,4,5; Rochwerg, Bram, MD, MSc6,7; Bagshaw, Sean M., MD, MSc8; Muscedere, John, MD9; Munshi, Laveena, MD, MSc10,11; Ferguson, Niall D., MD, MSc10,12; Seely, Andrew J. E., MD, PhD1,4,5,13; Cook, Deborah J., MD, MSc6,7; Dave, Chintan, MD14; Tanuseputro, Peter, MD, MHSc4,5,15,16; Kyeremanteng, Kwadwo, MD, MHA1,5,16

  1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON.
  2. Department of Emergency Medicine, University of Ottawa, Ottawa, ON.
  3. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON.
  4. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON.
  5. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON.
  6. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON.
  7. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON.
  8. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB.
  9. Department of Critical Care Medicine, Queen's University, Kingston, ON.
  10. Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON.
  11. Department of Medicine, Sinai Health System, Toronto, ON.
  12. Toronto General Hospital Research Institute, University Health Network, Toronto, ON.
  13. Department of Surgery, University of Ottawa, Ottawa, ON.
  14. Department of Medicine, University of Ottawa, Ottawa, ON.
  15. Bruyere Research Institute, Ottawa, ON.
  16. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON.

INTRODUCTION: Invasive mechanical ventilation is a common form of life support provided to critically ill patients. Frailty is an emerging prognostic factor for poor outcome in the Intensive Care Unit (ICU), however its association with adverse outcomes following invasive mechanical ventilation is unknown.  
 
OBJECTIVES: Evaluate the association between frailty, defined by the Clinical Frailty Scale (CFS), and outcomes of ICU patients receiving invasive mechanical ventilation. 
 
METHODS: We performed a retrospective analysis (2011-2016) of a prospectively collected registry from two hospitals of consecutive ICU patients ≥ 18 years of age receiving invasive mechanical ventilation. CFS scores were based on recorded pre-admission function at the time of hospital admission. The primary outcome was hospital mortality. Secondary outcomes included discharge to long-term care, extubation failure at time of first liberation attempt, and tracheostomy. We used multivariable logistic regression for adjust for relevant confounders.
 
RESULTS: We included 8,110 patients, and 2,529 (31.2%) had frailty (CFS ≥ 5). Frailty was associated with increased odds of hospital death (adjusted odds ratio [aOR]: 1.24 [95% confidence interval [CI]: 1.10-1.40) and discharge to long-term care (aOR 1.21 [95% CI: 1.13-1.35]). As compared to patients without frailty, patients with frailty had increased odds of extubation failure (aOR 1.17 [95% CI: 1.04-1.37]), hospital death following extubation failure (aOR 1.18 [95% CI: 1.07-1.28]), tracheostomy (aOR 1.17 [95% CI: 1.01-1.36]), and hospital death following tracheostomy (aOR 1.14 [95% CI: 1.03-1.25]).
 
CONCLUSIONS: The presence of frailty among patients receiving mechanical ventilation is associated with increased odds of hospital mortality, discharge to long-term care, extubation failure, and need for tracheostomy. This work provides novel data regarding the prognostic impact of frailty among mechanically ventilated patients, and may be utilized to facilitate goals-of-care discussions with critically ill patients and their families.
 


No references

ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Fernando, Shannon M., MD, MSc1,2; McIsaac, Daniel I., MD, MPH3,4,5; Rochwerg, Bram, MD, MSc6,7; Bagshaw, Sean M., MD, MSc8; Muscedere, John, MD9; Munshi, Laveena, MD, MSc10,11; Ferguson, Niall D., MD, MSc10,12; Seely, Andrew J. E., MD, PhD1,4,5,13; Cook, Deborah J., MD, MSc6,7; Dave, Chintan, MD14; Tanuseputro, Peter, MD, MHSc4,5,15,16; Kyeremanteng, Kwadwo, MD, MHA1,5,16

  1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON.
  2. Department of Emergency Medicine, University of Ottawa, Ottawa, ON.
  3. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON.
  4. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON.
  5. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON.
  6. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON.
  7. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON.
  8. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB.
  9. Department of Critical Care Medicine, Queen's University, Kingston, ON.
  10. Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON.
  11. Department of Medicine, Sinai Health System, Toronto, ON.
  12. Toronto General Hospital Research Institute, University Health Network, Toronto, ON.
  13. Department of Surgery, University of Ottawa, Ottawa, ON.
  14. Department of Medicine, University of Ottawa, Ottawa, ON.
  15. Bruyere Research Institute, Ottawa, ON.
  16. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON.

INTRODUCTION: Invasive mechanical ventilation is a common form of life support provided to critically ill patients. Frailty is an emerging prognostic factor for poor outcome in the Intensive Care Unit (ICU), however its association with adverse outcomes following invasive mechanical ventilation is unknown.  
 
OBJECTIVES: Evaluate the association between frailty, defined by the Clinical Frailty Scale (CFS), and outcomes of ICU patients receiving invasive mechanical ventilation. 
 
METHODS: We performed a retrospective analysis (2011-2016) of a prospectively collected registry from two hospitals of consecutive ICU patients ≥ 18 years of age receiving invasive mechanical ventilation. CFS scores were based on recorded pre-admission function at the time of hospital admission. The primary outcome was hospital mortality. Secondary outcomes included discharge to long-term care, extubation failure at time of first liberation attempt, and tracheostomy. We used multivariable logistic regression for adjust for relevant confounders.
 
RESULTS: We included 8,110 patients, and 2,529 (31.2%) had frailty (CFS ≥ 5). Frailty was associated with increased odds of hospital death (adjusted odds ratio [aOR]: 1.24 [95% confidence interval [CI]: 1.10-1.40) and discharge to long-term care (aOR 1.21 [95% CI: 1.13-1.35]). As compared to patients without frailty, patients with frailty had increased odds of extubation failure (aOR 1.17 [95% CI: 1.04-1.37]), hospital death following extubation failure (aOR 1.18 [95% CI: 1.07-1.28]), tracheostomy (aOR 1.17 [95% CI: 1.01-1.36]), and hospital death following tracheostomy (aOR 1.14 [95% CI: 1.03-1.25]).
 
CONCLUSIONS: The presence of frailty among patients receiving mechanical ventilation is associated with increased odds of hospital mortality, discharge to long-term care, extubation failure, and need for tracheostomy. This work provides novel data regarding the prognostic impact of frailty among mechanically ventilated patients, and may be utilized to facilitate goals-of-care discussions with critically ill patients and their families.
 


No references

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