• Kei Ouchi, Josephine Lo Bello, Edward Moseley, and Charlotta Lindvall.
• Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA; Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA. Electronic address: kouchi@partners.org.
• J Pain Symptom Manage. 2020 Nov 1; 60 (5): 101910261019-1026.

ContextEmergent mechanical ventilation represents an important inflection point in seriously ill older adults' illness trajectories. Data are lacking on the long-term prognosis after surviving mechanical ventilation to inform shared decision making in serious illness conversations.ObjectivesDescribe the long-term prognosis of older adults who survive emergency mechanical ventilation to inform shared decision making.MethodsThis is a retrospective cohort study from a single-center intensive care unit in an academic, urban, and tertiary care medical center. We included adults aged 75 years and older consecutively admitted with mechanical ventilation between 2008 and 2012 in the Multiparameter Intelligent Monitoring of Intensive Care III database. We excluded patients who were electively admitted. Our primary outcome was the long-term prognosis after leaving the hospital stratified by discharge location. Our secondary outcome was the frequency of documented serious illness conversations within 48 hours of hospitalization recommended by the National Quality Forum.ResultsWe identified 415 patients (454 hospital admissions) consecutively admitted to the intensive care unit. The median age was 82.6 years, 54.0% were female, 78.2% were white, non-Hispanic, and in-hospital mortality rate was 36.6%. Among the survivors, the median survival after hospital discharge was 163.5 days (interquartile range 37.5-476.8). Only 49.1% of patients had documented serious illness conversations within 48 hours of hospitalization. About 63.4% of patients (59 of 93) who were discharged to long-term acute care hospitals died by six months.ConclusionThis study demonstrated the long-term prognosis of older adults who underwent emergent mechanical ventilation. These data could be used to inform shared decision making in serious illness conversations.Copyright © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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