A latent class analysis of prolonged mechanical ventilation patients at a long-term acute care hospital: Subtype differences in clinical outcomes.
Heather Dunn, Laurie Quinn, Susan Corbridge and 4 others
PMID 30655004WHAT IT FOUND
Prolonged ventilation patients admitted to a long-term acute care hospital formed three profiles.
The acutely high-morbid profile was less likely to wean and more likely to die; ventilator days and discharge disposition did not differ.
Key findings
01In 249 patients on prolonged mechanical ventilation, three admission profiles were identified: low morbid, chronically high morbid, and acutely high morbid.
02The acutely high morbid group was less likely to wean from ventilation and more likely to die than the low morbid or chronically high morbid groups.
03There was no significant difference among the groups in ventilator days, long-term acute care stay, or discharge disposition.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective record review, so it can describe patterns but cannot prove that any profile caused death or failed weaning. The sample came from one 48-bed long-term acute care hospital, so the profiles may not match other hospitals or patient populations. The records were made for clinical care, not research, and some documentation was incomplete. Blood chemistry values were missing for some patients, with missingness of 1.6% to 6.8% per subject. Patients who left the hospital alive were not followed for one-year mortality, and deaths after transfer to a higher-level acute care hospital may be underreported. The study did not examine factors that could affect outcomes, including mobilization, sedation exposure, sepsis, or whether renal failure patients needed hemodialysis. The latent class model was exploratory and had no prior published long-term acute care hospital parameters for power analysis. It used a convenience sample of all eligible patients, not a random sample.
Declared interests
The supplied text lists non-U.S. government research support but does not name a funder or conflict-of-interest declarations.
The easy way to misread this
Do not conclude that the acutely high morbid profile caused death or failed weaning. The study looked back at records and the authors state that causal inference cannot be made.