Long-term respiratory stability of elderly patients recovering from acute respiratory failure and invasive mechanical ventilation: a retrospective cohort study

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.