Acquisition of new medical devices among the persistently critically ill: a retrospective cohort study in the Veterans Affairs

Viglianti, E. M., Carlton, E. F., McPeake, J. , Wang, X. Q., Seelye, S. and Iwashyna, T. J. (2022) Acquisition of new medical devices among the persistently critically ill: a retrospective cohort study in the Veterans Affairs. Medicine, 101(27), e29821. (doi: 10.1097/MD.0000000000029821) (PMID:35801748) (PMCID:PMC9259166)

Abstract

Patients who develop persistent critical illness remain in the ICU predominately because they develop new late-onset organ failure(s), which may render them at risk of acquiring a new medical device. The epidemiology and short-term outcomes of patients with persistent critical illness who acquire a new medical device are unknown. We retrospectively studied a cohort admitted to the Veterans Affairs (VA) ICUs from 2014 to 2019. Persistent critical illness was defined as an ICU length of stay of at least 14 days. Receipt of new devices was defined as acquisition of a new tracheostomy, feeding tube (including gastrostomy and jejunostomy tubes), implantable cardiac device, or ostomy. Logistic regression models were fit to identify patient factors associated with the acquisition of each new medical device. Among hospitalized survivors, 90-day posthospitalization discharge location and mortality were identified. From 2014 to 2019, there were 13,184 ICU hospitalizations in the VA which developed persistent critical illness. In total, 30.4% of patients (N = 3998/13,184) acquired at least 1 medical device during their persistent critical illness period. Patients with an initial higher severity of illness and prolonged hospital stay preICU admission had higher odds of acquiring each medical device. Among patients who survived their hospitalization, discharge location and mortality did not significantly differ among those who acquired a new medical device as compared to those who did not. Less than one-third of patients with persistent critical illness acquire a new medical device and no significant difference in short-term outcomes was identified. Future work is needed to understand if the acquisition of new medical devices is contributing to the development of persistent critical illness.

• Item Type: Articles
• Additional Information: This work was supported by the following National Institute of Health grants NHLBI K12HL138039 (TJI), K23HL157364 (EMV), NCATS KL2TR002241 (EFC), and VA IIR 17-045 (TJI).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McPeake, Dr Jo
• Authors: Viglianti, E. M., Carlton, E. F., McPeake, J., Wang, X. Q., Seelye, S., and Iwashyna, T. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: Medicine
• Publisher: Lippincott, Williams and Wilkins
• ISSN: 0025-7974
• ISSN (Online): 1536-5964
• Copyright Holders: Copyright © 2022 The Author(s)
• First Published: First published in Medicine 101(27): e29821
• Publisher Policy: Reproduced under a Creative Commons License