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The study conducted by Cox and coworkers included in this issue of Critical Care demonstrates that prolonged mechanical ventilation (MV; defined as MV for 21 days or longer) is more specific than Diagnosis Related Group 541/542 as a marker of resource utilization, hospital costs and potentially ineffective care. These patients also had greater 1-year mortality and lower functional ability than patients who had received MV for 48 to 96 hours, despite having better baseline functional status. However, predictors of mortality and long-term functional outcomes that are reliable and accurate at the level of the individual patient remain to be identified.

The long and difficult road to better evaluation of outcomes of prolonged mechanical ventilation: not yet a highway to heaven.