• Mei-Chuan Hung, Hsin-Ming Lu, Likwang Chen, Fu-Chang Hu, Soa-Yu Chan, Yuan-Horng Yan, Po-Sheng Fan, Ming-Shian Lin, Cheng-Ren Chen, Lu-Cheng Kuo, Chong-Jen Yu, and Jung-Der Wang.
• Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, No 17, Xuzhou Road, Taipei 100, Taiwan.
• Crit Care. 2011 Jan 1;15(2):R107.

IntroductionThe present study examined the median survival, life expectancies, and cumulative incidence rate (CIR) of patients undergoing prolonged mechanical ventilation (PMV) stratified by different underlying diseases.MethodsAccording to the National Health Insurance Research Database of Taiwan, there were 8,906,406 individuals who obtained respiratory care during the period from 1997 to 2007. A random sample of this population was performed, and subjects who had continuously undergone mechanical ventilation for longer than 21 days were enrolled in the current study. Annual incidence rates and the CIR were calculated. After stratifying the patients according to their specific diagnoses, latent class analysis was performed to categorise PMV patients with multiple co-morbidities into several groups. The life expectancies of different groups were estimated using a semiparametric method with a hazard function based on the vital statistics of Taiwan.ResultsThe analysis of 50,481 PMV patients revealed that incidence rates increased as patients grew older and that the CIR (17 to 85 years old) increased from 0.103 in 1998 to 0.183 in 2004 before stabilising thereafter. The life expectancies of PMV patients suffering from degenerative neurological diseases, stroke, or injuries tended to be longer than those with chronic renal failure or cancer. Patients with chronic obstructive pulmonary disease survived longer than did those co-morbid with other underlying diseases, especially septicaemia/shock.ConclusionsPMV provides a direct means to treat respiratory tract diseases and to sustain respiration in individuals suffering from degenerative neurological diseases, and individuals with either of these types of conditions respond better to PMV than do those with other co-morbidities. Future research is required to determine the cost-effectiveness of this treatment paradigm.

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