Esteban and colleagues conducted an international prospective cohort study of adult patients admitted to ICUs and receiving mechanical ventilation formore than 12 consecutive hours during March, 1998 and reported their results in 2002 . The study included 5183 patients in 361 ICUs in 20 countries. Mean duration of mechanical ventilation was 5.9 days and mean ICU length of stay was 11.2 days. Overall mortality was 31%, 52% in patients receiving mechanical ventilation for ARDS and 22% receiving mechanical ventilation for an exacerbation of chronic obstructive pulmonary disease (COPD). This large study confirmed previous reports ofhigher mortality rates in patients with ARDS andlowermortalityforCOPD patients with acute respiratoryfailure.
Analysis of the types of patients and their conditions included in this cohort provides important information about the practice of mechanical ventilation in the broad international critical care community. It also helps inform us about the relative magnitude of those populations in which long-term outcomes may be of interest. Of the 5183 patients, 17% were being ventilated for coma, 2% for neuromuscular disease, 13% for acute respiratory failure or chronic pulmonary disease, and 69% for acute respiratory failure without previous lung disease. Of those patients with acute respiratory failure, about a third (21% of the total of mechanically ventilated patients) were post-operative. Ten percent ofthe total had congestive heart failure, 2% were post cardiac arrest. Thirty-eight percent had either pneumonia (14%) or some other cause known to be associated with ALI (sepsis, trauma, aspiration) although whether criteria for ALI were met is not known. Only 4.5% of the total carried a diagnosis of ARDS. In this chapter we will deal with long-term outcomes in patients with acute respiratory failure superimposed on chronic pulmonary disease (mainly COPD), ALI/ARDS, and will briefly mention available data for mechanically ventilated patients with acute cardiogenic pulmonary edema.
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