Expectations and outcomes of prolonged mechanical ventilation*
Open accessAbstract
OBJECTIVE: To compare prolonged mechanical ventilation decision-makers' expectations for long-term patient outcomes with prospectively observed outcomes and to characterize important elements of the surrogate-physician interaction surrounding prolonged mechanical ventilation provision. Prolonged mechanical ventilation provision is increasing markedly despite poor patient outcomes. Misunderstanding prognosis in the prolonged mechanical ventilation decision-making process could provide an explanation for this phenomenon. DESIGN: Prospective observational cohort study. SETTING: Academic medical center. PATIENTS: A total of 126 patients receiving prolonged mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Participants were interviewed at the time of tracheostomy placement about their expectations for 1-yr patient survival, functional status, and quality of life. These expectations were then compared with observed 1-yr outcomes measured with validated questionnaires. The 1-yr follow-up was 100%, with the exception of patient death or cognitive inability to complete interviews. At 1 yr, only 11 patients (9%) were alive and independent of major functional status limitations. Most surrogates reported high baseline expectations for 1-yr patient survival (n = 117, 93%), functional status (n = 90, 71%), and quality of life (n = 105, 83%). In contrast, fewer physicians described high expectations for survival (n = 54, 43%), functional status (n = 7, 6%), and quality of life (n = 5, 4%). Surrogate-physician pair concordance in expectations was poor (all kappa = <0.08), as was their accuracy in outcome prediction (range = 23%-44%). Just 33 surrogates (26%) reported that physicians discussed what to expect for patients' likely future survival, general health, and caregiving needs. CONCLUSIONS: One-year patient outcomes for prolonged mechanical ventilation patients were significantly worse than expected by patients' surrogates and physicians. Lack of prognostication about outcomes, discordance between surrogates and physicians about potential outcomes, and surrogates' unreasonably optimistic expectations seem to be potentially modifiable deficiencies in surrogate-physician interactions.
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Patients receiving prolonged mechanical ventilation typically lack decisional capacity.
“These patients typically lack decisional capacity”
From Effects of a Personalized Web-Based Decision Aid for Surrogate Decision Makers of Patients With Prolonged Mechanical Ventilation (2019) · cites this paper as [3]
The Conclusions describe surrogate substituted judgment as integral to decisions about prolonged mechanical ventilation, supporting the implication that patients often do not make these decisions themselves. The paper does not establish that patients typically lack decisional capacity or report how often they do. (LLM, conf=0.75)
Experimental — accuracy not yet measuredFamily members must make challenging decisions between life-prolonging therapy and comfort-focused care, including withdrawal of life support.
“so family members must make challenging decisions between life-prolonging therapy and comfort-focused care, including withdrawal of life support (3).”
From Effects of a Personalized Web-Based Decision Aid for Surrogate Decision Makers of Patients With Prolonged Mechanical Ventilation (2019) · cites this paper as [3]
The Conclusions say that surrogates make a complicated decision about providing prolonged mechanical ventilation, and the Discussion describes uncertainty and distress surrounding decisions about life support. The paper does not specifically describe families choosing between life-prolonging therapy and comfort-focused care, including withdrawal of life support; its mention of withdrawal concerns physicians’ discomfort discussing it. (LLM, conf=0.84)
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- Authors
- Cox, C. E., Martinu, T., Sathy, S. J., Clay, A. S., Chia, J., Gray, A. L., Olsen, M. K., Govert, J. A., Carson, S. S., & Tulsky, J. A.
- Affiliations
- Duke University (US)
- University of North Carolina at Chapel Hill (US)
- ORCID
- Venue
- Critical Care Medicine
- Published
- 2009-11
- Volume
- 37
- Issue
- 11
- Pages
- 2888-2894
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC2766420
- OpenAlex
- W2085670126
- Cited by
- 319
- References
- 50
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 18 · 2023: 18 · 2022: 17 · 2021: 20 · 2020: 19 · 2019: 23 · 2018: 20 · 2017: 37 · 2016: 18 · 2015: 25 · 2014: 25 · 2013: 12 · 2012: 17
- FWCI
- 14.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23HL081048, K23HL067068)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Keywords
- prolonged mechanical ventilation, tracheostomy, patient expectations, surrogate decision-making, physician expectations, outcome prediction, quality of life, functional status, survival, end-of-life decisions
- MeSH terms
- Attitude to Health, Communication, Female, Follow-Up Studies, Health Status, Humans, Interviews as Topic, Male, Middle Aged, Patient Education as Topic, Professional-Patient Relations, Prospective Studies, Quality of Life, Surveys and Questionnaires, Respiration, Artificial, Tracheostomy, Survival Analysis, Caregivers, Hospital Mortality, Outcome Assessment, Health Care
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