How patients feel about prolonged mechanical ventilation 1 yr later*

OBJECTIVES: To elicit mechanical ventilation preferences among patients who previously received prolonged (>/=48 hrs) mechanical ventilation, to identify patient characteristics associated with mechanical ventilation preferences, and to assess the association between the intensive care experience and mechanical ventilation preferences. DESIGN: Prospective cohort study conducted between June of 1997 and July of 2000. SETTING: Four intensive care units at a tertiary care institution. PATIENTS: Former critically ill patients (n = 133; mean age +/- sd, 51.8 +/- 17.1 yrs; 49% women) who survived for 12 months after prolonged mechanical ventilation. MEASUREMENTS: Patients' preferences toward their actual mechanical ventilation experiences, by asking patients to reflect on the decision to apply mechanical ventilation made 1 yr earlier. Preferences for hypothetical situations, by asking patients to evaluate mechanical ventilation choices, assuming that their experiences had been different in terms of pain or discomfort, familial financial burden and stress, and health status after mechanical ventilation. RESULTS: Of the 133 patients, 115 (86.5%) would have chosen mechanical ventilation, with younger and healthier patients having higher odds of choosing mechanical ventilation than older and sicker patients, respectively. One fourth of patients who initially would have chosen mechanical ventilation would have refused this therapy had their families' financial burdens been beyond certain thresholds. A similar proportion would have refused mechanical ventilation with greater mechanical ventilation pain or discomfort. CONCLUSION: Although most subjects would have made the same decision to receive mechanical ventilation, younger and healthier subjects were most likely to favor mechanical ventilation. Many patients indicated that factors such as the amount of pain or discomfort from mechanical ventilation and their families' financial burden would cause them to refuse this potentially life-saving intervention.