A latent class analysis of prolonged mechanical ventilation patients at a long-term acute care hospital: Subtype differences in clinical outcomes.

RATIONALE

Patients on prolonged mechanical ventilation (PMV) at Long-Term Acute Care Hospital's (LTACHs) are clinically heterogeneous making it difficult to manage care and predict clinical outcomes.

OBJECTIVES

Identify and describe subgroups of patients on PMV at LTACHs and examine for group differences.

METHODS

Latent class analysis was completed on data obtained during medical record review at Midwestern LTACH.

MAIN RESULTS

A three-class solution was identified. Class 1 contained young, obese patients with low clinical and co-morbid burden; Class 2 contained the oldest patients with low clinical burden but multiple co-morbid conditions; Class 3 contained patients with multiple clinical and co-morbid burdens. There were no differences in LTACH length of stay [F(2,246) = 2.243, p = 0.108] or number of ventilator days [F(2,246) = 0.641, p = 0.528]. Class 3 patients were less likely to wean from mechanical ventilation [χ(2, N = 249) = 25.48, p < 0.001] and more likely to die [χ(2, N = 249) = 23.68, p < 0.001].

CONCLUSION

Patient subgroups can be described that predict clinical outcomes. Class 3 patients are at higher risk for poor clinical outcomes when compared to patients in Class 1 or Class 2.