Abstract
Long-term outcomes after discharge remain a challenge in critically ill elderly patients. We aimed to evaluate the long-term survival without repeat mechanical ventilation (MV) in elderly survivors of acute respiratory failure (ARF). We retrospectively included 1533 elderly patients aged 65 years or older who were admitted with ARF and invasive MV, successfully recovered, were liberated from MV, and were discharged between January 2010 and December 2019. Patients who were MV-dependent at discharge or died in the hospital were excluded. The primary outcome was survival without repeat MV. Secondary outcomes were factors associated with survival without repeat MV. Among enrolled patients, 524 patients were aged 65–74 years, 613 were aged 75–84 years, and 396 were aged 85 years or older. Kaplan–Meier analysis revealed that the overall 1-year survival rate without repeat MV was 73%. Pneumonia, MV ≥ 21 days, and older age were the 3 most important risk factors associated with worse outcomes. The subgroup analysis for the 3 most important risk factors revealed that patients without these risk factors had much better outcomes compared to those with all 3 risk factors (90% vs. 47% 1-year survival rate without repeat MV). Overall, elderly ARF survivors exhibited poor long-term respiratory outcomes, influenced by multiple factors. These findings highlight the need for careful clinical assessment and further research.
Data availability
Data is provided within the manuscript and supplementary information files.
References
Marshall, D. C., Hatch, R. A., Gerry, S., Young, J. D. & Watkinson, P. Conditional survival with increasing duration of ICU admission: An observational study of three intensive care databases. Crit. Care Med. 48 (1), 91–97. https://doi.org/10.1097/CCM.0000000000004082 (2020).
Moitra, V. K., Guerra, C., Linde-Zwirble, W. T. & Wunsch, H. Relationship between ICU length of stay and long-term mortality for elderly ICU survivors. Crit. Care Med. 44 (4), 655–662. https://doi.org/10.1097/CCM.0000000000001480 (2016).
Esteban, A. et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am. J. Respir Crit. Care Med. 188, 220–230. https://doi.org/10.1164/rccm.201212-2169OC (2013).
Chen, C. J., Shi, H. Y., Lee, K. T. & Huang, T. Y. In-hospital mortality prediction in patients receiving mechanical ventilation in Taiwan. Am. J. Crit. Care. 22, 506–513. https://doi.org/10.4037/ajcc2013950 (2013).
Wang, C. H. et al. Predictive factors of in-hospital mortality in ventilated intensive care unit: A prospective cohort study. Med. (Baltim). 96, e9165. https://doi.org/10.1097/MD.0000000000009165 (2017).
Hsu, C. H. et al. Prognostic nomogram for elderly patients with acute respiratory failure receiving invasive mechanical ventilation: A nationwide population-based cohort study in Taiwan. Sci. Rep. 10, 13161. https://doi.org/10.1038/s41598-020-70130-x (2020).
Gayat, E. et al. Determinants of long-term outcome in ICU survivors: Results from the FROG-ICU study. Crit. Care. 22 (1), 8. https://doi.org/10.1186/s13054-017-1922-8 (2018).
Doherty, Z. et al. Long-term outcomes of hospital survivors following an ICU stay: A multi-centre retrospective cohort study. PLoS One. 17 (3), e0266038. https://doi.org/10.1371/journal.pone.0266038 (2022).
Lokhandwala, S. et al. One-year mortality after recovery from critical illness: A retrospective cohort study. PLoS One. 13 (5), e0197226. https://doi.org/10.1371/journal.pone.0197226 (2018).
Jubran, A. et al. Long-term outcome after prolonged mechanical ventilation. A long-term acute-care hospital study. Am. J. Respir Crit. Care Med. 199, 1508–1516. https://doi.org/10.1164/rccm.201806-1131OC (2019).
Huang, C. Five years follow up of patient receiving prolonged mechanical ventilation: Data for a single center in Taiwan. Front. Med. (Lausanne). 9, 1038915. https://doi.org/10.3389/fmed.2022.1038915 (2022).
Ferrante, L. E. et al. Functional trajectories among older persons before and after critical illness. JAMA Intern. Med. 175 (4), 523–529. https://doi.org/10.1001/jamainternmed.2014.7889 (2015).
Zizza, C. A., Ellison, K. J. & Wernette, C. M. Total water intakes of community-living middle-old and oldest-old adults. J. Gerontol. Biol. Sci. Med. Sci. 64 (4), 481–486. https://doi.org/10.1093/gerona/gln045 (2009).
Halter, J. B. et al. Hazzard’s Geriatric Medicine and Gerontology Vol. 871 (McGraw-Hill, 2009).
Miller, P. R. et al. ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high-risk patients. J. Trauma. 51, 223–230 (2001).
Kornblith, L. Z. et al. Mechanical ventilation weaning and extubation after spinal cord injury: A Western Trauma Association multicenter study. J. Trauma. Acute Care Surg. 75, 1060–1070 (2013).
Ranzani, O. T., Zampieri, F. G., Park, M. & Salluh, J. I. Long-term mortality after critical care: What is the starting point? Crit. Care. 17 (5), 191. https://doi.org/10.1186/cc13024 (2013).
Ware, L. B. & Matthay, M. A. The acute respiratory distress syndrome. N Engl. J. Med. 342, 1334–1349 (2000).
Matthay, M. A. et al. Acute respiratory distress syndrome. Nat. Rev. Dis. Primers. 5, 18. https://doi.org/10.1038/s41572-019-0069-0 (2019).
Bos, L. D. J. & Ware, L. B. Acute respiratory distress syndrome: causes, pathophysiology, and phenotypes. Lancet 400 (10358), 1145–1156. https://doi.org/10.1016/S0140-6736(22)01485-4 (2022).
Acknowledgements
The authors express their appreciation to the Department of Medical Education and Research and the Research Centre of Medical Informatics in Kaohsiung Veterans General Hospital for their inquiries and assistance with data processing. We also thank Mrs. Yu-Jung Chang for assisting with the literature search, ICD-10 code transformation, and classification. This research received a grant from the Kaohsiung Veterans General Hospital [Grant Number: KSVGH112-003].
Author information
Authors and Affiliations
Contributions
C.F.C. and W.R.L. conceived and designed the study. C.H.Y., C.F.C. and W.R.L. collected the data. C.H.Y., C.F.C., W.R.L., J.S.C. and Y.S.C. analyzed and interpreted the data. C.F.C. and W.R.L. conceptualized and drafted the manuscript. All authors have reviewed the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Chen, CF., Yin, CH., Lin, WR. et al. Long-term respiratory stability of elderly patients recovering from acute respiratory failure and invasive mechanical ventilation: a retrospective cohort study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-42264-x
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-026-42264-x
